Abstract:

In view of the growing concern about the use of qualitative approach in health research, this article aims to analyze how the qualitative theoretical-methodological framework of HIV prevention is presented in empirical research. We conducted an integrative literature review with the following guiding questions: “How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?”; “What are the limits and potentials of the qualitative methodological designs employed?”. In the qualitative methodological discussion, five dimensions guided the methodological course and the presentation of findings, from the analysis of the characterization of qualitative studies to the contextualization of the studies and the methodological approaches used, highlighting the use of semi-structured interviews with thematic content analysis. We also examined social categories and analytical references, drawing attention to the plurality of these theoretical-conceptual references and to the authors’ polyphony, and identified the limits and potentials of qualitative research. This study focuses on a scientific topic that is related to a wide variety of social groups and analyzes how they are affected by it, examining issues related to social inequality and other analytical possibilities surrounding HIV prevention, and providing resources for a comprehensive methodological discussion. Hence, avoiding the risk of conducting qualitative research based on checklists that limit inventiveness and openness to different designs and forms of execution and analysis is as pivotal as ensuring that the research is consistent and detailed in publications.

Keywords:
Qualitative Research; Prevention; HIV

Resumo:

Em vista da crescente preocupação com o uso da abordagem qualitativa na pesquisa em saúde, este artigo visa analisar como o referencial teórico-metodológico qualitativo da prevenção do HIV é apresentado na pesquisa empírica. Realizou-se uma revisão integrativa da literatura com as seguintes questões norteadoras: “Como o referencial teórico-metodológico qualitativo se expressa nas pesquisas empíricas de prevenção do HIV?”; “Quais são os limites e o potencial dos desenhos metodológicos qualitativos empregados?”. Cinco dimensões orientaram o fluxo metodológico e a apresentação dos resultados para a discussão metodológica qualitativa, desde a análise da caracterização dos estudos qualitativos até a contextualização destes e as abordagens metodológicas utilizadas, destacando o uso de entrevistas semiestruturadas com análise de conteúdo temático. Além disso, foram examinadas categorias sociais e referências analíticas, destacando-se a pluralidade destas referências teórico-conceituais e a polifonia dos autores, e foram identificados os limites e as possibilidades da pesquisa qualitativa. Assim, esse é um tema científico que articula o estudo com uma diversidade significativa de grupos sociais e como eles são afetados, assim como questões relacionadas à desigualdade social e outras possibilidades analíticas que envolvem a prevenção do HIV, fornecendo recursos para uma discussão metodológica abrangente. Portanto, evitar o risco de realizar pesquisas qualitativas com base em roteiros que limitam a inventividade e a abertura para diferentes desenhos e maneiras de executar e analisar a abordagem qualitativa é tão essencial quanto garantir que a pesquisa seja consistente e detalhada nas publicações.

Palavras-chave:
Pesquisa Qualitativa; Prevenção; HIV

Resumen:

Ante la creciente preocupación por el uso del enfoque cualitativo en la investigación en salud, este artículo tiene el objetivo de analizar cómo se presenta el marco teórico-metodológico cualitativo de la prevención del VIH en la investigación empírica. Se realizó una revisión integradora de la literatura con las siguientes preguntas orientadoras: “¿Cómo se expresa el marco teórico-metodológico cualitativo en las investigaciones empíricas de prevención del VIH?”; “¿Cuáles son los límites y el potencial de los diseños metodológicos cualitativos empleados?”. Cinco dimensiones han guiado el flujo metodológico y la presentación de los resultados para la discusión metodológica cualitativa, desde el análisis de la caracterización de los estudios cualitativos hasta su contextualización y los enfoques metodológicos utilizados, destacando el uso de entrevistas semiestructuradas con análisis de contenido temático. Además, se examinaron las categorías sociales y los referentes analíticos, destacando la pluralidad de estos referentes teórico-conceptuales y la polifonía de los autores, y se identificaron los límites y las posibilidades de la investigación cualitativa. Así, este es un tema científico que articula el estudio con una diversidad significativa de grupos sociales y cómo son afectados, así como cuestiones relacionadas con la desigualdad social y otras posibilidades analíticas que involucran la prevención del VIH, proporcionando recursos para una discusión metodológica completa. Por lo tanto, evitar el riesgo de realizar investigaciones cualitativas basadas en guiones que limitan la creatividad y la apertura a diferentes diseños y formas de ejecutar y analizar el enfoque cualitativo es tan esencial como asegurar una investigación consistente y minuciosa en las publicaciones.

Palabras-clave:
Investigación Cualitativa; Prevención; VIH

Introduction

Qualitative research has its theoretical-methodological foundations established on references from the Social and Human Sciences, displaying analytical concerns about the meanings attributed to subjects’ experiences in their social interaction contexts ¹1. Denzin NK, Lincoln YS, editors. The SAGE handbook of qualitative research. Thousand Oaks: SAGE Publications; 2011.. It seeks to apprehend the representations, beliefs, perceptions, opinions, and other factors resulting from the interpretations and experiences of subjects in their social-historical contexts.

Epidemiological or clinical studies usually cannot fully support health prevention, especially HIV prevention. Knowing the profile of the population at risk of HIV infection, of people living with HIV and the clinical picture associated with HIV may not be good prevention strategies. The effectiveness of HIV prevention policies, programs, and actions also depends on evidence from qualitative studies guided by social theories ²2. Monteiro SS, Villela WV, Soares PS. The interaction between axes of inequality in studies on discrimination, stigma and HIV/AIDS: contributions to the recent international literature. Glob Public Health 2013; 8:519-33..

Although these types of studies are already incorporated ³3. Mizuno Y, Gelaude DJ, Crepaz N, Kamitani E, DeLuca JB, Leighton CA, et al. Health care providers' views on clinic infrastructure and practice models that may facilitate HIV preexposure prophylaxis (PrEP) prescribing: a qualitative meta-synthesis. Health Promot Pract 2022; 23:999-1014.^,44. Leblanc NM, Flores DD, Barroso J. Facilitators and barriers to HIV screening. Qual Health Res 2016; 26:294-306., their use in the formulation, implementation, and guidance of prevention policies is still incipient. They occupy a complementary or secondary place in analysis frameworks shaped by evidence from epidemiological and clinical studies, which strongly emphasize biomedical knowledge ⁵5. Kumar S, Gruskin S, Khosla R, Narasimhan M. Human rights and the sexual and reproductive health of women living with HIV: a literature review. J Int AIDS Soc 2015; 18:20290.. Frequently, meta-syntheses in the field of HIV prevention focus on subjects’ knowledge, access, and experiences related to the use of preventive methods or social and legal dimensions that cross prevention policies ⁶6. Rubincam C, Lacombe-Duncan A, Newman PA. Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies. Expert Rev Vaccines 2016; 15:331-47..

Especially in Public Health, there are concerns about the quality of qualitative research: its conception, methodological development, and outcomes disclosure are questioned both by researchers and by scientific journals ⁷7. Morse J. Why the qualitative health research (QHR) review process does not use checklists. Qual Health Res 2021; 31:819-21.^,88. Patias ND, Von Hohendorff J. Critérios de qualidade para artigos de pesquisa qualitativa. Psicol Estud 2019; 24:e43536.. Despite different editorial orientations, these show the necessary explanation of the main aspects that must be reported in publications of qualitative studies. Although no consensus have been reached on the definition of quality criteria for qualitative research ⁸8. Patias ND, Von Hohendorff J. Critérios de qualidade para artigos de pesquisa qualitativa. Psicol Estud 2019; 24:e43536., challenges constantly arise around this discussion ⁹9. Flick U. Managing quality in qualitative research. London: SAGE Publications; 2007..

Taking into account these methodological concerns surrounding qualitative research, this study is based on the following guiding questions: “How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?”; “What are the limits and potentials of the qualitative methodological designs?”. In this sense, the general objective of this article is to analyze how the qualitative theoretical-methodological framework presents itself in empirical research on HIV prevention, pointing out limits and potentials for future research in this field.

Methods

We performed an integrative review of the literature on HIV prevention via published empirical articles ¹⁰10. Cronin MA, George E. The why and how of the integrative review. Organ Res Methods 2020; 26:168-92. with a qualitative methodological approach, and applying the ENTREQ Protocol ¹¹11. Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 2012; 12:181. (Figure 1).

We selected references from the Virtual Health Library (VHL), SciELO, PubMed, and Scopus databases, basing choices on syntax and using descriptors previously validated in DeCS (Health Science Descriptors)/MESH (Medical Subject Headings): (HIV) AND (prevention) AND (qualitative research) (Table 1). The decision to use validated descriptors instead of search terms, which was adopted by some indexed journals, resulted in the exclusion of studies that could have been included in our review but were not captured in the selection based on descriptors. The advanced search considered the field titles and abstracts in the previous selection without time restriction. We were unable to access two articles, even after contacting the main authors. The search process was conducted from July to August 2022.

Original articles considered for inclusion presented results of empirical qualitative research on HIV prevention, focusing on the perspective of population groups. Literature review studies were excluded, as well as studies methodologically evaluating programs and public policies focused on the perspective of health professionals or other prevention agents, studies on perinatal transmission of HIV, surveys with people living with HIV and serodifferent couples , and studies related to the exposure to HIV through sexual violence or occupational accidents. The Rayyan online platform (https://www.rayyan.ai/) was used to the selection of articles.

After our final selection, we included 42 articles in this review and created five dimensions to extract their data and analyze the potentials and limits of qualitative research in the health care field:

(1) Characterization of publications (year of publication, journal, corresponding author’s institution/country and gender);

(2) Contextualization of qualitative studies (objectives, referenced theoretical framework, definition of the study object, study groups/populations);

(3) Methodological approaches used (study design, methods or techniques, justification for data sources, sample description, data analysis, program used for data analysis, ethical issues);

(4) Social categories and references used for analysis (theoretical approach to methodology and social categories as references for analysis, social categories and references);

(5) Limits and potentials identified in the qualitative research.

Results

Analyzing the first established dimension, we found that the publication date of the chosen studies ranged from 2011 to 2020, and that the studies were conducted in various regions and countries, such as the United States (n = 14) and Brazil (n = 9). The articles were published in different journals from disciplinary and thematic areas of public health. Based on the names of the leading authors, we found that women were the preeminent authors in most publications (26 out of 42).

While examining the second dimension of the analysis (contextualization of qualitative studies), we noticed that all articles presented their research objectives. Although 15 of the 42 papers did not clarify which theoretical framework was chosen for the research design, almost all articles included references to previous studies in the field of HIV prevention. Articles explaining the chosen theoretical framework relied on references such as theoretical-conceptual frameworks of hegemonic masculinity ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.; risk ¹⁴14. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.; vulnerability ¹⁵15. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.; the theory of social representations ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,1717. Marques SC, Tyrrell MAR, Oliveira DC. Educational practices for HIV/AIDS prevention among users of the basic healthcare system in Rio de Janeiro/Brazil. REME Rev Min Enferm 2013; 17:538-46.^,1818. Góis ARS, Barbosa PFC, Gonçalves VHGB, Silva VF, Góis CGS, Oliveira RC, et al. Educação em saúde nas escolas: conhecimentos de adolescentes sobre o vírus da imunodeficiência humana. Research, Society and Development 2021; 10:e51210313636.; medical anthropology ¹⁹19. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2020. Lesser J, Oakes R, Koniak-Griffin D. Vulnerable adolescent mothers' perceptions of maternal role and HIV risk. Health Care Women Int 2003; 24:513-28.; a theoretical framework of the intergenerational dialogues model ²¹21. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.; African womanism and the Afrocentric theory ²²22. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.; the socioecological model ²³23. Ssekamatte T, Isunju JB, Naume M, Buregyeya E, Mugambe RK, Wanyenze RK, et al. Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda. BMC Infect Dis 2020; 20:932.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.; studies anchored in the Health Belief model; and the information-motivation-behavioral skills model ²⁵25. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,2626. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83..

Regarding definition of the object, the dimensions investigated were varied. Some studies focused on constructs or mediating processes related to the use of preventive methods and/or to the participation in preventive interventions. When this was the case, information, knowledge, social representations, beliefs, attitudes, decision-making, perceptions, and acceptability constituted investigation objects. Other studies investigated care experiences related to preventive methods, including the use and adherence to such methods and patients’ interactions with health professionals and services ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.^,2525. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,2626. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,3232. Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from young partnered gay, bisexual, and other men who have sex with men on the adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-46.^,3333. Bjertrup PJ, Mmema N, Dlamini V, Ciglenecki I, Mpala Q, Matse S, et al. PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. BMC Public Health 2021; 21:727.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.. We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men ¹³13. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,3636. Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,3838. Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al. "Now we are in a different time; various bad diseases have come". Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67.; men who have sex with men (MSM) ²⁵25. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.; women ²⁶26. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,3333. Bjertrup PJ, Mmema N, Dlamini V, Ciglenecki I, Mpala Q, Matse S, et al. PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. BMC Public Health 2021; 21:727.^,4444. Katz AWK, Mansoor LE, Tsidya M, Mathebula F, Singh D, Siva S, et al. Using emoji stickers to understand end-user opinions of the dapivirine vaginal ring for HIV prevention. AIDS Behav 2021; 25:3955-66.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80.; African-Americans ²¹21. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.; women over 50 years ¹⁹19. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.; young people (cisgender, transgender, MSM) ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,4848. Löfgren J, Byamugisha J, Tillgren P, Rubenson B. The perspectives of in-school youths in Kampala, Uganda, on the role of parents in HIV prevention. Afr J AIDS Res 2009; 8:193-200.; and sex workers ²³23. Ssekamatte T, Isunju JB, Naume M, Buregyeya E, Mugambe RK, Wanyenze RK, et al. Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda. BMC Infect Dis 2020; 20:932.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.. Still at the interface with preventive measures, some studies have analyzed issues related to vulnerability ¹⁵15. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,2222. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,4949. Garcia S, Souza FM. Vulnerabilidades ao HIV/aids no contexto brasileiro: iniquidades de gênero, raça e geração. Saúde Soc 2010; 19 Suppl 2:9-20.; explained risk behavior as the central object for analysis ¹⁴14. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5151. Meylakhs P, Aasland A, Grønningsæter A. “Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33.^,5252. Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22.; masculinity ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,3636. Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217.; gender ²²22. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221. and sexuality ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.; and social support networks ⁴¹41. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82..

Our third dimension of analysis investigated different methodological approaches. Among the articles we selected, some arose from research conceived as exclusively qualitative ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1919. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2121. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,2222. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,2525. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,2626. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,3333. Bjertrup PJ, Mmema N, Dlamini V, Ciglenecki I, Mpala Q, Matse S, et al. PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. BMC Public Health 2021; 21:727.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,3636. Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,3838. Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al. "Now we are in a different time; various bad diseases have come". Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,4848. Löfgren J, Byamugisha J, Tillgren P, Rubenson B. The perspectives of in-school youths in Kampala, Uganda, on the role of parents in HIV prevention. Afr J AIDS Res 2009; 8:193-200.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.; some were based on articles with a mixed design ¹⁵15. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,1616. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,3232. Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from young partnered gay, bisexual, and other men who have sex with men on the adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-46.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8.; and some reported having a “qualitative” focus on the “phase” or “component” of broader research ¹³13. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,2020. Lesser J, Oakes R, Koniak-Griffin D. Vulnerable adolescent mothers' perceptions of maternal role and HIV risk. Health Care Women Int 2003; 24:513-28.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4444. Katz AWK, Mansoor LE, Tsidya M, Mathebula F, Singh D, Siva S, et al. Using emoji stickers to understand end-user opinions of the dapivirine vaginal ring for HIV prevention. AIDS Behav 2021; 25:3955-66.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,5252. Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22., such as clinical trials and community-based research.

As for the explanation of the theoretical anchoring of the different methodological designs, we found studies that were based on ethnography ²⁰20. Lesser J, Oakes R, Koniak-Griffin D. Vulnerable adolescent mothers' perceptions of maternal role and HIV risk. Health Care Women Int 2003; 24:513-28.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.; medical anthropology ¹⁹19. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.; interpretive anthropology ¹⁵15. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.; case study ⁴⁷47. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.; phenomenological study ⁴³43. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.; community-based study ³⁴34. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.; and the Theory of Social Representations ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.. However, many studies lacked an explanation of the methodological design, citing only the methodological approach and the techniques for production and analysis ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,1414. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,2121. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,2222. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.^,2525. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,2626. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,3838. Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al. "Now we are in a different time; various bad diseases have come". Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.^,4444. Katz AWK, Mansoor LE, Tsidya M, Mathebula F, Singh D, Siva S, et al. Using emoji stickers to understand end-user opinions of the dapivirine vaginal ring for HIV prevention. AIDS Behav 2021; 25:3955-66.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80.^,4848. Löfgren J, Byamugisha J, Tillgren P, Rubenson B. The perspectives of in-school youths in Kampala, Uganda, on the role of parents in HIV prevention. Afr J AIDS Res 2009; 8:193-200.^,4949. Garcia S, Souza FM. Vulnerabilidades ao HIV/aids no contexto brasileiro: iniquidades de gênero, raça e geração. Saúde Soc 2010; 19 Suppl 2:9-20.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5252. Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8..

As for the production of empirical data, the most used data production techniques in the research were in-depth interviews with a semi-structured guide ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,1414. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,1515. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,2121. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,2424. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.^,2525. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,2626. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,3232. Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from young partnered gay, bisexual, and other men who have sex with men on the adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-46.^,3333. Bjertrup PJ, Mmema N, Dlamini V, Ciglenecki I, Mpala Q, Matse S, et al. PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. BMC Public Health 2021; 21:727.^,3636. Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.^,4444. Katz AWK, Mansoor LE, Tsidya M, Mathebula F, Singh D, Siva S, et al. Using emoji stickers to understand end-user opinions of the dapivirine vaginal ring for HIV prevention. AIDS Behav 2021; 25:3955-66.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80.^,4848. Löfgren J, Byamugisha J, Tillgren P, Rubenson B. The perspectives of in-school youths in Kampala, Uganda, on the role of parents in HIV prevention. Afr J AIDS Res 2009; 8:193-200.^,5151. Meylakhs P, Aasland A, Grønningsæter A. “Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33. and focus groups ³⁰30. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8., often combined in studies ²³23. Ssekamatte T, Isunju JB, Naume M, Buregyeya E, Mugambe RK, Wanyenze RK, et al. Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda. BMC Infect Dis 2020; 20:932.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,3838. Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al. "Now we are in a different time; various bad diseases have come". Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,4343. Bistoquet M, Makinson A, Tribout V, Perrollaz C, Bourrel G, Reynes J, et al. Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP. AIDS Res Ther 2021; 18:2.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,5252. Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22. or narrative interviews ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1919. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.. Anthropologically-oriented studies used field diaries as a tool for collecting information, along with other strategies, such as semi-structured interviews ¹⁹19. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2222. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.. In studies with online surveys, data collection technologies were also employed ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,3232. Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from young partnered gay, bisexual, and other men who have sex with men on the adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-46.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8..

Qualitative research is expected to align data collection and analysis techniques with specific theoretical references that guide analytical procedures; however, eight out of the 42 selected studies did not report which references guided the analyses. In the studies that did report these references, different approaches were proposed, such as the Grounded Theory ²⁵25. Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, et al. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-8.^,3131. Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, et al. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. Subst Abuse Treat Prev Policy 2020; 15:89.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5151. Meylakhs P, Aasland A, Grønningsæter A. “Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33., the Ecological Model Theory ²⁴24. Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women's Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav 2021; 25:667-78.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8., and content analysis ²¹21. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.. Thematic analysis was also referenced among the studies ²⁶26. Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, et al. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-83.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.. Some studies were also founded on the method of interpretation of the senses, based on hermeneutic-dialectical principles ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144., on the Theory of Social Representations ¹⁶16. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80., and on phenomenology ²⁷27. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35..

In almost all studies, thematic analyses of the corpus of transcribed contents were performed, with the codification and construction of analytical categories. As support for data analysis, 29 of the 42 studies used one of the following software: QSR Nvivo (in its different versions); Ensemble de Programmes Permettant L’Analyse des Evoctions (EVOC); Atlas.Ti; ALCESTE, HYPERBASE; Dedoose, Ethnograph 5.0; Tri-Deux Mots version 2.2; and QSR-N6.

The ethical aspects involved in the research development were reported in 29 of the 42 studies. In some of them, only the approval by research ethics bodies/committees was mentioned (16), while in others, the adopted ethical procedures were described in detail (13).

Through our fourth established dimension, which included the social categories and references for analyses in the studies, we sought to map, among other aspects, the segments and classifications of social differentiation included in the articles. A diversity of social categories was also included in the theoretical-methodological models that guided the analyses. Some journals explicitly mentioned their chosen social categories while describing their methodological concerns ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,1414. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,1616. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,1919. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2121. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,2222. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62.^,3232. Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from young partnered gay, bisexual, and other men who have sex with men on the adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-46.^,3434. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.^,3838. Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al. "Now we are in a different time; various bad diseases have come". Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,4949. Garcia S, Souza FM. Vulnerabilidades ao HIV/aids no contexto brasileiro: iniquidades de gênero, raça e geração. Saúde Soc 2010; 19 Suppl 2:9-20.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5151. Meylakhs P, Aasland A, Grønningsæter A. “Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33.. Among these categories, gender stood out in various studies, such as those dealing with hegemonic masculinity ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1313. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144. and African-American women ²²22. Shambley-Ebron DZ. My sister, myself. J Transcult Nurs 2009; 20:28-36.. Gender was also intertwined with other social markers ¹³13. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,3333. Bjertrup PJ, Mmema N, Dlamini V, Ciglenecki I, Mpala Q, Matse S, et al. PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. BMC Public Health 2021; 21:727.; such as socioeconomic statuses ³⁴34. Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-81.. We also identified the sexuality category, present in discussions about the impact of racism and socioeconomic status on sexual behavior ¹⁵15. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.. Some articles discussed the exposure of populations to social vulnerabilities ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1414. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,1515. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,4040. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,4949. Garcia S, Souza FM. Vulnerabilidades ao HIV/aids no contexto brasileiro: iniquidades de gênero, raça e geração. Saúde Soc 2010; 19 Suppl 2:9-20.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221. and sought to link different social categories in their analyses: an example is a study that identified how people of different ethnic-racial identities, genders, and ages can be more or less vulnerable to HIV.

During the analysis of our last dimension (limits and potentialities of the researches), we found that some articles did not mention the impact(s) of their methodology on the research results ¹⁴14. Paicheler G. General population and HIV prevention: from risk to action. Cad Saúde Pública 1999; 15 Suppl 2:93-105.^,1616. Santos Couto PL, Santos Paiva M, Freitas de Oliveira J, Tosoli Gomes AM, Argolo Teixeira M, Teixeira Boa Sorte E. Sexuality and HIV prevention: consensus and dissent of Catholic youths. Invest Educ Enferm 2018; 36:e06.^,2828. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, et al. Understanding demand for PrEP and early experiences of PrEP use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav 2020; 24:2149-62. and suggested new studies or interventions on the initial themes ¹²12. Marques Junior JS, Gomes R, Nascimento EF. Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS. Ciênc Saúde Colet 2012; 17:511-20.^,1919. Rodrigues DAL, Praça NS. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV. Rev Gaúcha Enferm 2010; 31:321-7.^,2121. Robinson G. Qualitative study of African-American women's intergenerational dialogue for HIV prevention. West J Nurs Res 2021; 43:409-15.^,2727. Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-35.^,2929. Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, et al. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782.^,3939. Jacques-Aviñó C, Andrés A, Roldán L, Fernández-Quevedo M, Olalla PG, Díez E, et al. Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España. Ciênc Saúde Colet 2019; 24:4707-16.^,4141. Maina G, Strudwick G, Lalani Y, Boakye F, Wilton L, Nelson LE. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care 2018; 29:70-82.^,4242. Wirtz AL, Zelaya CE, Peryshkina A, Latkin C, Mogilnyi V, Galai N, et al. Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: implications for prevention. AIDS Care 2014; 26:387-95.^,4848. Löfgren J, Byamugisha J, Tillgren P, Rubenson B. The perspectives of in-school youths in Kampala, Uganda, on the role of parents in HIV prevention. Afr J AIDS Res 2009; 8:193-200.^,5050. Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV risk behaviors among African American women with at-risk male partners. J AIDS Clin Res 2013; 4:221.^,5353. Cahill SR, Wang TM, Fontenot HB, Geffen SR, Conron KJ, Mayer KH, et al. Perspectives on sexual health, sexual health education, and HIV prevention from adolescent (13-18 years) sexual minority males. J Pediatr Health Care 2021; 35:500-8.^,5454. Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14.. Other articles indicated the importance of studies for drawing up public policies focused on HIV prevention ¹³13. dos Santos LA, Couto MT, Mathias A, Grangeiro A. Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida. Salud Colect 2019; 15:e2144.^,1515. Magno L, Castellanos MEP. Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil. Rev Saúde Pública 2016; 50:76.^,2323. Ssekamatte T, Isunju JB, Naume M, Buregyeya E, Mugambe RK, Wanyenze RK, et al. Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda. BMC Infect Dis 2020; 20:932.^,3030. Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2020; 17:22-8.^,3535. Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145:e20192204.^,3737. Maibvise C, Mavundla TR. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland. Afr J AIDS Res 2014; 13:281-9.^,4545. Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, et al. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930.^,4949. Garcia S, Souza FM. Vulnerabilidades ao HIV/aids no contexto brasileiro: iniquidades de gênero, raça e geração. Saúde Soc 2010; 19 Suppl 2:9-20., and some reported that the findings evidenced through the qualitative methodology were essential for the development of interventions, serving as a guidance for public polices and prevention programs ³⁶36. Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217.^,4444. Katz AWK, Mansoor LE, Tsidya M, Mathebula F, Singh D, Siva S, et al. Using emoji stickers to understand end-user opinions of the dapivirine vaginal ring for HIV prevention. AIDS Behav 2021; 25:3955-66.^,4646. Fernandes JCL. Práticas educativas para a prevenção do HIV/AIDS: aspectos conceituais. Cad Saúde Pública 1994; 10:171-80.^,4747. Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a videogame for adolescent human immunodeficiency virus prevention. Games Health J 2012; 1:294-8.^,5252. Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22.. Some studies discussed the limitations of the findings of qualitative research: one of them raised concerns over the possible generalization of results of prevention strategies for young MSM ⁴⁰40. Easton D, Iverson E, Cribbin M, Wilson E, Weiss G; Community Intervention Trial For Youth Group. Space: the new frontier in HIV prevention for young men who have sex with men. AIDS Educ Prev 2007; 19:465-78., and another signaled the low number of participants in researches on injectable drug users’ experiences with HIV prevention ⁵¹51. Meylakhs P, Aasland A, Grønningsæter A. “Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33..

Discussion

Our integrative review included 42 articles selected from the largest and most expressive health databases in the world. Most of the articles (19) were published between 2011 and 2020, and publications were made both in public health journals and in journals specialized in HIV prevention.

The majority of the analyzed studies were conducted in the United States and in Brazil, and had mostly female authors.

We hypothesize that women prevailed in the authorship of the selected articles because the women’s movement, along with the activism related to AIDS and with the gay movement, has played an important role in actions aimed at policies, interventions, and prevention actions focused on HIV. In this sense, the women who dealt with this issue, regardless of their sexual orientation, joined other movements, becoming active both in the demanding groups’ demonstrations and in the academic research on the subject. Another factor that may have contributed to this female prevalence is the geographical area in which the studies were conducted: in Brazil, for example, women are the majority (60%) of researchers in Life and Health Sciences, while in Computer Sciences and Mathematics the female presence does not even reach 25%. In terms of scientific production in general, from 2014 to 2017, Brazil was the Ibero-American country with the most women signing scientific articles - females represented 72% of the total authors ⁵⁵55. Gomes R. Participation of social movements in gay and lesbian health. Ciênc Saúde Colet 2021; 26:2291-300.^,5656. Prusa A, Picanço L. A snapshot of the status of women in Brazil: 2019. https://www.wilsoncenter.org/sites/default/files/media/documents/publication/status_of_women_in_brazil_2019_final.pdf (accessed on 24/Jan/2023).
https://www.wilsoncenter.org/sites/defau... .

Publications of selected qualitative studies on HIV prevention began to appear in the late 1990s, increasing in the first decade of the 2000s and growing even more expressively during the year 2021. Many studies that originated these publications were conducted before the COVID-19 pandemic, including longitudinal studies and some with mixed methodologies. However, in the first six months of 2022, publications began to report studies made during the pandemic, usually conducted remotely and using information technologies. This last increase probably occurred due to a worsening concern over the access to services for sustaining HIV prevention strategies in the context of the pandemic ⁵⁷57. Hussein J. COVID-19: what implications for sexual and reproductive health and rights globally? Sex Reprod Health Matters 2020; 28:1746065.. Even so, the increase in publications about HIV from the 2000s onwards demonstrates that studies on the subject have been intensified, possibly in response to new global trends in the epidemic and to the use of new technologies and institutional programs aimed at HIV prevention.

Furthermore, we observed that the profile of participants varied widely across studies, both in the categories of social differentiation included in the theoretical-methodological models and in the data analyses. Different theoretical frameworks were also employed to support the conducted analyses. However, most studies significantly lack details describing the theoretical framework used for their research design.

The diverse social groups included in the studies portrays the populations that are the focus of most HIV prevention initiatives, and sections of highly vulnerable groups (young transgender people, young refugees, people who are homeless, and MSM in rural areas). Qualitative research is highly important, as it allows for advances in the general understanding of experiences and vulnerability contexts linked to HIV, which contributes to the development of prevention policies, especially those aimed at groups undergoing a systematic violation of human rights and those addressing the resurgence or stagnation of the HIV epidemic. At the same time, there is a noteworthy absence of research on the use of ARV-based HIV prevention methods by young people and adolescents, and of research with trans men, a social group that is often not reached by prevention policies.

Most studies we analyzed were exclusively qualitative. The second most used methodological approach was that of mixed methods, including a qualitative component, of explanatory and exploratory models, and the third was the use of a qualitative component as part of broader research with different methods. We also observed a predominance of analyses of participants’ experiences with prevention measures, and interviews and focus groups stood out as frequently used data production techniques. Lastly, most studies did not provide clear descriptions of the criteria used for determining sample size, and limited the description of ethical aspects to a mere citation of the protocol approval number. In this way, a very traditional approach seems to predominate in data production and in the engagement of more vulnerable populations in the research process.

Research with people in vulnerable contexts requires less conventional methodologies and approaches - which is not only a matter of methodology, but also one of ethics. The use of methods that are not appropriate or sufficiently adapted to consider social vulnerabilities can result in the exclusion of vulnerable populations from research. Those who are unwilling to go beyond traditional methodological limits perpetuate a research culture in which vulnerable groups and people are neglected, considered too “difficult” to be included in research. In this sense, methodological diversification is a tool for promoting more empathetic and democratic research participation, and includes the use of approaches that provide greater visibility and stimulates participants’ resilience instead of their susceptibility ⁵⁸58. Aldridge J. Working with vulnerable groups in social research: dilemmas by default and design. Qual Res 2014; 14:112-30..

During the methodological analysis, we also found that the selected studies displayed a plurality of theoretical-conceptual references, which could indicate a profusion of perspectives from different study fields (cultural, gender, decolonial studies, Social Psychology, Medical Anthropology, Public Health) and a polyphony of authors.

In most of the selected studies, the authors conducted analyses of the empirical material from the corpus of transcribed content, using different thematic analysis strategies and frequently employing information resources (software) to support such analyses. Some authors particularly linked their analyses to further contextual analyses of the investigated social categories. The term “social categories” is traditional in the fields of Social Sciences and Humanities in Health, and even after four decades of studies in this area on HIV and prevention, recent articles continue to use the term “social markers” without major concerns regarding how it is considered in filiation theory and in more recent studies, such as those on intersectionality. The (inter)relations between markers such as social class, gender, race/ethnicity, sexual orientation, among others, must be analyzed in historical conjunctures and specific social situations, and authors should keep in mind the idea that differences crosscut social actions, both to determine how much to enable changes in the meaning of these actions promoted by cultural practices of resistance and recreation of the social world ⁵⁹59. Hirano LFK. Marcadores sociais das diferenças: rastreando a construção de um conceito em relação à abordagem interseccional e a associação de categorias. In: Hirano LFK, Acuña M, Machado BF, editors. Marcadores sociais das diferenças: fluxos, trânsitos e intersecções. Goiânia: Editora Imprensa Universitária; 2019. p. 27-55..

Final considerations

This article results from the scientific community’s growing concern over the characteristics of qualitative research. We assessed the quality of different qualitative researches published in scientific journals on health and the lack of determination in their design, conduction, and analysis. Scientific journals have incorporated the use of checklists to provide greater integrity and transparency in the report of qualitative research, but this practice has been the subject of intense discussion ⁷. It is necessary to ensure that research is reported in a coherent and detailed manner, so that it is possible to evaluate it according to the value of the research product, that is, based on criteria of originality, substantiveness, and contributions that are not foreseen in checklists, not least because they are not - and cannot be - their purpose. Avoiding the risk of guiding qualitative research on checklists that restrict inventiveness and openness to different designs is as important as ensuring that the research is performed coherently and reported in detail in publications, and also allows for the emergence of various ways of conducting and analyzing the context of the qualitative approach.

HIV prevention studies based on qualitative approaches have high scientific relevance, as they articulate a relevant diversity of social groups, revealing their struggles by exposing issues related to social inequality, social justice, and human rights, recurrent and important aspects surrounding HIV prevention.

This study has both strengths and limitations. As strengths, we can highlight the search strategy, which was designed to be sensitive to all qualitative publications in the area and did not have any time or language restrictions, thus further reducing the chances of excluding publications that met the adopted eligibility criteria. The use of descriptors limits access to articles and journals that use keywords. In addition, we conducted the search in the largest and most representative health databases. The objective of our analysis was to examine methodological aspects of qualitative articles on HIV prevention, but it is impossible to summarize the results obtained in the researches conducted by all the selected studies. We encourage the creation of future literature reviews with the same objective as ours. Given the growing interest in high-quality qualitative research in health studies, our contribution goes beyond the specific contributions of this type of approach in the field of HIV prevention. Given the volume and complexity of studies on HIV prevention, which have the potential to effectively address the HIV pandemic, it is necessary to reflect on the importance of qualitative research and of its contributions to the development of this relevant field of knowledge and practice.

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