As one of the main strategies currently available to prevent HIV, pre-exposure prophylaxis (PrEP) has been adopted in Brazil since 2017 in the context of a broader approach for populations at high risk of infection. The high efficacy and relative ease of implementation have motivated the use of PrEP in varied contexts around the world. However, the absence of Brazilian guidelines to implement PrEP among adolescents under 18 years of age supported the PrEP1519 study from 2018 onwards. This cohort was conducted in three state capitals in Brazil (Belo Horizonte, São Paulo, and Salvador) with male adolescents who have sex with men (aMSM) and adolescent transsexual women and travestis (aTWT) aged 15-19 years to determine the effectiveness of PrEP among these populations¹ Dourado I, Magno L, Greco DB, Zucchi EM, Ferraz D, Westin MR, et al. Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil. Cad Saude Publica. 2023;39(Suppl 1):e00143221. https://doi.org/10.1590/0102-311xen143221
https://doi.org/10.1590/0102-311xen14322... .

Since its conception, PrEP1519 was designed following an interdisciplinary and multiprofessional perspective based on the collection of both qualitative and quantitative data. The study coordinators also prioritized the recruitment of a diverse sample of participants, considering gender identity, class, race, and experiences of violence or discrimination. This commitment to diversity and inclusion ensured that the study results represented and were relevant to the populations most vulnerable to HIV infection.

The engagement between researchers, community members, and healthcare providers, among others, was key to the knowledge production and publication of academic papers with great relevance to address the HIV/AIDS epidemic in Brazil. Analyses on the acceptability of PrEP² Dourado I, Soares F, Magno L, Amorim L, Eustorgio Filho M, Leite B, et al. Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study). J Adolesc Health. 2023;73(6S):S33-42. https://doi.org/10.1016/j.jadohealth.2023.09.005
https://doi.org/10.1016/j.jadohealth.202... , the strategies to recruit adolescents at high risk of infection³Magno L, Soares F, Zucchi EM, Eustórgio M, Grangeiro A, Ferraz D, et al. Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods. Arch Sex Behav. 2023;52(2):703-19. https://doi.org/10.1007/s10508-022-02371-y
https://doi.org/10.1007/s10508-022-02371... , the frequency of a range of sexually transmitted infections (including HIV)⁴Oliveira CM, Marques LM, Medeiros DS, Salgado VJ, Soares F, Magno L, et al. Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections among adolescent men who have sex with men and transgender women in Salvador, Northeast Brazil. Epidemiol Infect. 2023;151:e196. https://doi.org/10.1017/s095026882300170x
https://doi.org/10.1017/s095026882300170... , the use of HIV preventive methods⁵Martins GB, Pinheiro TF, Ferraz D, Grangeiro A, Zucchi EM. Use of HIV prevention methods and contexts of the sexual practices of adolescent gay and bisexual men, travestis, and transgender women in São Paulo, Brazil. Cad Saude Publica. 2023;39(Suppl 1):e00161521. https://doi.org/10.1590/0102-311XEN161521
https://doi.org/10.1590/0102-311XEN16152... , and the construction of links between health services and target populations⁶Oliveira R, Silva L, Duarte FM, Brasil SA, Castellanos MEP, Magno L, et al. Building bridges to care: the experience of peer navigation in enabling linkage to PrEP for adolescent men who have sex with men and transgender women. Cad Saude Publica. 2023;39(Suppl 1):e00176821. https://doi.org/10.1590/0102-311xen176821
https://doi.org/10.1590/0102-311xen17682... have been published in various media, including specialized scientific journals. These publications not only expand scientific knowledge, but also provide practical guidelines for the effective implementation of HIV prevention programs.

This supplement of Revista de Saúde Pública builds on an additional and no less important set of PrEP1519 findings. Consistent with its broad interdisciplinary and methodological origins, the reader will find a collection of quantitative and qualitative studies on a variety of topics. While quantitative studies focus on the prevalence of hepatitis and predictors of condomless anal sex in aMSM and aTWT, qualitative analyses address the use of an intersectional perspective to investigate HIV prevention, social representations of HIV and care in newly diagnosed youths, and the categories “risk” and “pleasure” in affective-sexual relationships protected by PrEP use.

This supplement also includes studies on the perceptions and practices of healthcare providers who follow the administration of PrEP and the challenges faced by adolescents who use PrEP on demand. These studies are crucial to understanding the barriers and facilitators in PrEP adoption, enabling interventions to be tailored to better meet the adolescents’ needs. Given that the PrEP1519 spanned the COVID-19 pandemic, its impact on the relationships aTWT establish with PrEP services was also considered. Despite its additional challenges, the pandemic offered opportunities to innovate and adapt health services to continuously provide essential care.

Together, the studies in this supplement provide original and essential knowledge to address the HIV/AIDS epidemic in adolescents under 18, especially aMSM and aTWT. The focus on multiply marginalized populations is undoubtedly a strength of the study, promoting the visibility of populations that are often made invisible, including their specific health care needs and strategies to address them. Initiatives such as PrEP1519 enable the improvement of health policies by combating rather than exacerbating social injustices in the frequency and distribution of health issues.

The editorial board of Revista de Saúde Pública is very proud and grateful for the opportunity to support the dissemination of these works, thus contributing to the promotion of health and the mitigation of health inequities. We hope this supplement will inspire new studies and public policies that continue to further HIV prevention and care for the most vulnerable populations.

References

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