Challenges facing HIV treatment as prevention in Brazil: an analysis drawing on literature on testing

Monteiro, Simone Souza; Brigeiro, Mauro; Vilella, Wilza Vieira; Mora, Claudia; Parker, Richard

doi:10.1590/1413-81232018245.16512017

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Ciênc. saúde colet. 24 (5) • May 2019 • https://doi.org/10.1590/1413-81232018245.16512017 copy

Challenges facing HIV treatment as prevention in Brazil: an analysis drawing on literature on testing

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

According to current global AIDS guidelines, HIV testing is key to the success of the ‘treatment as prevention’ (TasP) strategy and the control of AIDS. In view of Brazil’s commitment to these guidelines, this article characterizes the principles and justifications underpinning TasP and discusses implementation challenges. The analysis draws on a systematic review of the literature (2005 to 2015) on recruitment and testing strategies for men who have sex with men. This approach was adopted based on the assumption that current knowledge on HIV testing can offer valuable insights into the foundations of global AIDS policies and their uptake in local contexts. Based on the analysis of the 65 articles selected, we suggest that TasP represents a shift in the AIDS prevention paradigm. There is an overlap between prevention and care and the new approach places major emphasis on biomedical and psychological knowledge. The TasP approach fails to address the factors associated with HIV vulnerability and the stigma surrounding AIDS and undermines the participation of activists and PLWHA as autonomous producers of preventive of preventive practices. We argue that, to ensure the effective implementation of TasP in Brazil, it is necessary to discuss issues such as the protection of human rights and the structural problems facing Brazil’s public health system.

Systematic review; Testing; HIV/AIDS; Prevention; MSM

Counseling and Voluntary Testing	Treatment as Prevention
Prevention focused on voluntary testing and counseling, guided by raising awareness of vulnerability to HIV and the promotion of preventions, mainly by counseling and encouraging condom use	Prevention focused on routine testing, aimed at the initiation of treatment in order to reduce the viral loadand break the chain of transmission of HIV; counseling takes on a less important role and condom loses its importance
Principle of exceptionality of testing to detect HIV, rooted in the principal of informed and voluntary consent	Principle of normalization of testing, valuing the collective benefits of access to treatment over the right to individual autonomy
Provision of voluntarytestingin health services (e.g.: VCTCs) and activities in nonmedical settings	Provision of testing in private and public settings outside conventional health services and emphasis on outreach strategies for the most vulnerable groups
Participation of NGOs and social movements in advocacy efforts andpolicy formulation	NGOs and social movements work to support outreach strategies for testing of so called key-populations

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

SS Monteiro was responsible for the coordination of the study, working on methodological design, discussion of results and writing and review of the article. M Brigeiro and C Mora were responsible for the methodological design, for the search, organization and analysis of the data and for the writing and revision of the article. WV Villela and R Parker acted in the discussion of the results and review of the article.

Testing	testeo	Testagem
anonymous testing	pruebas anónimas	testes anônimos
Serologic test	pruebas serológicas	testes sorológicos, sorodiagnóstico
Aids serodiagnosis	serodiagnóstico del sida	Não identificado no DECS
Prevention	prevención	Prevenção
Aids	Sida	Aids
Counseling	consejería	Aconselhamento
testing strategies	estrategias de testeo	Não identificado no DECS
Terms present in the indexed literature, but NOT recognized in the MeSH and DeCS
testing methods	Métodos de testeo	Métodos de testagem
mobile HIV testing	_____________	_____________
mobile testing	_____________	_____________
mobile unit	_____________	_____________
treatment as prevention	_____________	_____________
combination HIV prevention	_____________	_____________
HIV prevention	Prevención del VIH	Prevenção do HIV
HIV prevention strategies	_____________	_____________
POC Point of Care	_____________	_____________
home-based	_____________	_____________
self-testing
community-based
community mobilization
MSM	HSH	HSH
Homosexual	homosexual	homossexual
Bisexual	bisexual	bissexual
assessment	acceso	acesso
Barriers	barreras	barreiras
willingness	aceptabilidad	aceitabilidade

1	Agarwal A, Hamdallah M, Swain SN, Mukherjee S, Singh N, Mahapatra S, et al. Implementation of a confidential helpline for men having sex with men in India. JMIR mHealth uHealth. 2015;3(1):e17.
2	Bai X, Xu J, Yang J, Yang B, Yu M, Gao Y, et al. HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: implications for HIV prevention. J Int AIDS Soc. 2014;17:18848
3	Bavinton BR, Brown G, Hurley M, Bradley J, Keen P, Conway DP, et al. Which gay men would increase their frequency of HIV testing with home self-testing? AIDS Behav. 201317(6):2084–92.
4	Baytop C, Royal S, Hubbard McCree D, Simmons R, Tregerman R, Robinson C, et al. Comparison of strategies to increase HIV testing among African-American gay, bisexual, and other men who have sex with men in Washington, DC. AIDS Care 2014; 26(5):608–12.
5	Beattie TSH, Bhattacharjee P, Suresh M, Isac S, Ramesh BM, Moses S. Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India. J Epidemiol Community Health. 2012; 66 Suppl 2:ii42–8.
6	Bernstein KT, Liu K-L, Begier EM, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches. Arch Intern Med. 2008;168(13):1458–64.
7	Bilardi JE, Walker S, Read T, Prestage G, Chen MY, Guy R, et al. Gay and bisexual men’s views on rapid self-testing for HIV. AIDS Behav. 2013;17(6):2093–9.
8	Bingham T a, Secura GM, Behel SK, Bunch JG, Simon P a, MacKellar DA. HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001-2002. Sex Transm Dis. 2008; 35(6):631–6.
9	Blas MM, Menacho LA, Alva IE, Cabello R, Orellana ER. Motivating men who have sex with men to get tested for HIV through the internet and mobile phones: a qualitative study. PLoS One. 2013; 8(1): e 54012.
10	Brookmeyer R, Boren D, Baral SD, Bekker L-G, Phaswana-Mafuya N, Beyrer C, et al. Combination HIV prevention among MSM in South Africa: results from agent-based modeling. PLoS One. 2014;9(11):e112668
11	Carnicer-Pont D, Barbera-Gracia MJ, Fernandez-Davila P, Garcia de Olalla P, Munoz R, Jacques-Avino C, et al. Use of new technologies to notify possible contagion of sexually-transmitted infections among men. Gac Sanit. 2015;
12	Castillo M, Palmer BJ, Rudy BJ, Fernandez MI. Creating partnerships for HIV prevention among YMSM: the Connect Protect(R) Project and House and Ball Community in Philadelphia. J Prev Interv Community. 2012;40(2):165–75.
13	Champenois K, Le Gall J-MJ-M, Jacquemin C, Jean S, Martin C, Rios L, et al. ANRS-COM’TEST: description of a community-based HIV testing intervention in non-medical settings for men who have sex with men. BMJ; 2012; 2(2):e 000693.
14	Cinta F, Jordi C, Rafael M, Victoria G, Kati Z. Incremento en la prevalencia del VIH y en las conductas de riesgo asociadas en hombres que tienen sexo con hombres: 12 años de encuestas de vigilancia conductual en Cataluña. Gac Sanit 2010; 24(1): 40–6
15	Cohall A, Dini S, Nye A, Dye B, Neu N, Hyden C. HIV testing preferences among young men of color who have sex with men. Am J Public Health; 2010;100(10):1961–6
16	Delaney KP, Kramer MR, Waller LA, Flanders WD, Sullivan PS. Using a geolocation social networking application to calculate the population density of sex-seeking gay men for research and prevention services. J Med Internet Res; 2014;16(11):e 249
17	Dewsnap CH, McOwan A. A review of HIV point-of-care tests. Int J STD AIDS. 2006;17(6):357–9
18	Dorell CG, Sutton MY, Oster AM, Hardnett F, Thomas PE, Gaul ZJ, et al. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS. 2011;25(11):657–64
19	El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. J Acquir Immune Defic Syndr. United States 2010;55 Suppl 2:S98–101
20	Ellen JM, McCree DH, Muvva R, Chung S-E, Miazad RM, Arrington-Sanders R, et al. Recruitment approaches to identifying newly diagnosed HIV infection among African American men who have sex with men. Int J STD AIDS. 2013;24(5):335–9
21	Fairley CK, Law M, Chen MY. Eradicating syphilis, hepatitis C and HIV in MSM through frequent testing strategies. Curr Opin Infect Dis. 2014;27(1):56–61
22	Fan EL. HIV testing as prevention among MSM in China: the business of scaling-up. Glob Public Health. 2014;9(1-2):85–97
23	Fernández-Balbuena S, de la Fuente L, Hoyos J, Rosales-Statkus ME, Barrio G, Belza M-JM-J, et al. Highly visible street-based HIV rapid testing: is it an attractive option for a previously untested population? A cross-sectional study. Sex Transm Infect 2014;90(2):112–8
24	Firestone R, Rivas J, Lungo S, Cabrera A, Ruether S, Wheeler J, et al. Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation. BMC Public Health. 2014;14:1244
25	Flowers P, McDaid LM, Knussen C. Exposure and impact of a mass media campaign targeting sexual health amongst Scottish men who have sex with men: an outcome evaluation. BMC Public Health. 2013;13:737
26	Frasca T, Balan I, Ibitoye M, Valladares J, Dolezal C, Carballo-Dieguez A. Attitude and behavior changes among gay and bisexual men after use of rapid home HIV tests to screen sexual partners. AIDS Behav; 2014;18(5):950–7
27	Fuqua V, Chen Y-H, Packer T, Dowling T, Ick TO, Nguyen B, et al. Using social networks to reach Black MSM for HIV testing and linkage to care. AIDS Behav. 2012;16(2):256–65
28	Gilbert M, Hottes TS, Kerr T, Taylor D, Fairley CK, Lester R, et al. Factors associated with intention to use internet-based testing for sexually transmitted infections among men who have sex with men. J Med Internet Res. 2013;15(11):e254
29	Golden MR, Gift TL, Brewer DD, Fleming M, Hogben M, St Lawrence JS, et al. Peer referral for HIV case-finding among men who have sex with men. AIDS. 2006 ;20(15):1961–8
30	Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR mHealth uHealth 2014;2(4):e 47
31	Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men. Sex Transm Infect. 2012;88(5):368–74
32	Gu J, Lau JTF, Tsui H. Psychological factors in association with uptake of voluntary counselling and testing for HIV among men who have sex with men in Hong Kong. Public Health. 2011;125(5):275–82.
33	Gumy C, Jeannin A, Balthasar H, Huissoud T, Jobin V, Hausermann M, et al. Five-year monitoring of a gay-friendly voluntary counselling and testing facility in Switzerland: who got tested and why? BMC Public Health. 2012;12:422.
34	Halkitis PN, Kupprat SA, McCree DH, Simons SM, Jabouin R, Hampton MC, et al. Evaluation of the relative effectiveness of three HIV testing strategies targeting African American men who have sex with men (MSM) in New York City. Ann Behav Med. 2011;42(3):361–9.
35	Han L, Bien CH, Wei C, Muessig KE, Yang M, Liu F, et al. HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr. 2014;67(2):216–21
36	Hao C, Huan X, Yan H, Yang H, Guan W, Xu X, et al. A randomized controlled trial to evaluate the relative efficacy of enhanced versus standard voluntary counseling and testing on promoting condom use among men who have sex with men in China. AIDS Behav. 2012;16(5):1138–47
37	Hong NTT, Wolfe MI, Dat TT, McFarland D a., Kamb ML, Thang NT, et al. Utilization of HIV voluntary counseling and testing in Vietnam: an evaluation of 5 years of routine program data for national response. AIDS Educ Prev. 2011;23(3 Suppl):30–48.
38	Hoyos J, Belza MJ, Fernandez-Balbuena S, Rosales-Statkus ME, Pulido J, de la Fuente L. Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme. BMC Public Health. 2013;13:791
39	Hoyos J, Fernández-Balbuena S, de la Fuente L, Sordo L, Ruiz MM, Barrio G, et al. Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers. J Int AIDS Soc. 2013;16:18560.
40	Hu Q, Xu J, Chu Z, Zhang J, Yun K, Shi F, et al. Barriers to acceptance of provider-initiated testing and counseling among men who have sex with men in Shenyang, China: a cross-sectional study. Biomed Res Int. 2013;2013:280969
41	Huebner DM, Binson D, Pollack LM, Woods WJ. Implementing bathhouse-based voluntary counselling and testing has no adverse effect on bathhouse patronage among men who have sex with men. Int J STD AIDS. 2012;23(3):182–4.
42	Huebner DM, Binson D, Dilworth SE, Neilands TB, Grinstead O, Woods WJ. Rapid vs. standard HIV testing in bathhouses: what is gained and lost? AIDS Behav. 2010;14(3):688–96.
43	Ifekandu C, Suleiman A, Aniekwe O. The cost-effectiveness in the use of HIV counselling and testing-mobile outreaches in reaching men who have sex with men (MSM) in northern Nigeria. J Int AIDS Soc. 2014;17(4 Suppl 3):19610
44	Laperrière H. Evaluation of STD/HIV/AIDS peer-education and danger: a local perspective. Ciênc saúde coletiva. 2006;13(6):1817–24
45	Lippman SA, Périssé AR, Veloso VG, Sullivan PS, Buchbinder S, Sineath RC, Grinsztejn B. Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey. Cad Saude Pública. 2014;30(4):724–34
46	Mackellar DA, Hou S-I, Whalen CC, Samuelsen K, Sanchez T, Smith A, et al. Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis. 2011;38(5):419–28.
47	MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. J Acquir Immune Defic Syndr. 2005; 38(5):603–14
48	MacPherson P, Chawla A, Jones K, Coffey E, Spaine V, Harrison I, et al. Feasibility and acceptability of point of care HIV testing in community outreach and GUM drop-in services in the North West of England: a programmatic evaluation. BMC Public Health. 2011;11:419.
49	Mansergh G, Naorat S, Jommaroeng R, Jenkins RA, Jeeyapant S, Kanggarnrua K, et al. Adaptation of Venue-Day-Time Sampling in Southeast Asia to Access Men Who Have Sex with Men for HIV Assessment in Bangkok. Field methods. Division HIV/AIDS Prevention, Centers Disease Control & Prevention, Atlanta: Sage Publications; 2006;18(2):135–52.
50	Marcus U, Ort J, Grenz M, Eckstein K, Wirtz K, Wille A. Risk factors for HIV and STI diagnosis in a community-based HIV/STI testing and counselling site for men having sex with men (MSM) in a large German city in 2011 inverted question mark2012. BMC Infect Dis. 2015 Jan;15(1):14.
51	Margolis AD, Joseph H, Belcher L, Hirshfield S, Chiasson MA. “Never testing for HIV” among men who have sex with men recruited from a sexual networking website, United States. AIDS Behav. 2012;16(1):23–9.
52	Marley G, Kang D, Wilson EC, Huang T, Qian Y, Li X, et al. Introducing rapid oral-fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges. BMC Public Health.; 2014;14:422.
53	Marsh KA, Reynolds GL, Rogala BE, Fisher DG, Napper LE. Who chooses a rapid test for HIV in Los Angeles County, California? Eval Health Prof. 2010;33(2):177–96.
54	Martinez O, Carballo-Dieguez A, Ibitoye M, Frasca T, Brown W, Balan I. Anticipated and actual reactions to receiving HIV positive results through self-testing among gay and bisexual men. AIDS Behav. 2014;18(12):2485–95
55	Mattioli S, Corbelli GM, Pieralli S, Esposti MD. HIV test: which is your best? A National survey on testing preferences among MSM in Italy. J Int AIDS Soc.; 2014;17(4 Suppl 3):1959
56	Mayer KH, Ducharme R, Zaller ND, Chan PA, Case P, Abbott D, et al. Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse. J Acquir Immune Defic Syndr. 2012;59(2):194–8
57	McCree DH, Millett G, Baytop C, Royal S, Ellen J, Halkitis PN, et al. Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men. Am J Public Health. 2013;103(10):1851–6.
58	Mitchell JW. Gay male couples’ attitudes toward using couples-based voluntary HIV counseling and testing. Arch Sex Behav. 2014;43(1):161–71
59	O’Byrne P, MacPherson P, Ember A, Grayson M-O, Bourgault A. Overview of a gay men’s STI/HIV testing clinic in Ottawa: clinical operations and outcomes. Can J Public Health. 2014;105(5):e389–94.
60	O’Byrne P, Macpherson P, Roy M, Kitson C. Overviewing a Nurse-Led, Community-Based HIV PEP Program: Applying the Extant Literature in Frontline Practice. Public Health Nurs. 2015 Apr
61	Pattanasin S, Wimonsate W, Chonwattana W, Tongtoyai J, Chaikummao S, Sriporn A, et al. Loss to follow-up and bias assessment among a cohort of Thai men who have sex with men in Bangkok, Thailand. Int J STD AIDS. 2015. Mar
62	Prestage G, Jin F, Zablotska IB, Imrie J, Grulich AE, Pitts M. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health. 2008 ;5(2):119–23
63	Prost A, Chopin M, McOwan A, Elam G, Dodds J, Macdonald N, et al. “There is such a thing as asking for trouble”: taking rapid HIV testing to gay venues is fraught with challenges. Sex Transm Infect. 2007;83(3):185–8.
64	Purcell DW, Mizuno Y, Smith DK, Grabbe K, Courtenay-Quick C, Tomlinson H, et al. Incorporating couples-based approaches into HIV prevention for gay and bisexual men: opportunities and challenges. Arch Sex Behav. 2014;43(1):35–46
65	Silva SM, Spiassi AL, Alves D de C, Guedes D de J, Leigo R de O, Silvia Moreira da S, et al. Redução de danos: estratégia de cuidado com populações vulneráveis na cidade de Santo André - SP. Saude soc. 2009;18(supl.2):100–3.