High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil

  • Gustavo Machado RochaEmail author
  • Mark Drew Crosland Guimarães
  • Ana Maria de Brito
  • Ines Dourado
  • Maria Amélia Veras
  • Laio Magno
  • Carl Kendall
  • Ligia Regina Franco Sansigolo Kerr
  • The Brazilian HIV/MSM Group
Original Paper


The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18–24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.


HIV/AIDS Risk behavior Behavior surveillance MSM Brazil 


El objetivo de este estudio fue estimar la prevalencia y los factores asociados con el coito anal receptivo sin protección (URAI), estratificados por edad (18–24 o más de 25 años), en una muestra de 4,129 HSH reclutados por Respondent Driven Sampling en 12 ciudades de Brasil en 2016. La prevalencia de URAI fue mayor entre los HSH más jóvenes (41.9% frente a 29.7%) (p < 0.01). El análisis multivariado indicó que la percepción de riesgo, la identidad sexual, el estado de salud autoevaluado y el sexo comercial estaban asociados con el URAI entre los HSH más jóvenes. La historia de violencia sexual, el sexo con parejas más jóvenes, tener más de 6 parejas y el debut sexual sin protección se asociaron con URAI entre los HSH de mayor edad. El estado civil, el hecho de tener una pareja estable y reportar sexo solo con hombres se asociaron con URAI en ambos grupos. A pesar del acceso a condones y lubricantes, es posible que los esfuerzos preventivos no alcancen a los HSH de manera efectiva. Se deben considerar los enfoques de intervención específicos para la edad, incluidos el estigma, la discriminación y la percepción del riesgo.



This study was carried out with financial support and data provided by the Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, of the Secretariat for Health Surveillance of the Ministry of Health. We would like to thank to all participants for their time, and the support from NGOs and health services for this study.

The Brazilian HIV/MSM Group is composed of the following collaborators: Alexandre Kerr Pontes, Universidade Federal do Rio de Janeiro, Rio de Janeiro; Ana Cláudia Camillo, Fundação Alfredo da Mata, Manaus; Ana Maria de Brito, Ageu Magalhães, Oswaldo Cruz Foundation, Recife; Ana Rita Coimbra Motta-Castro, FIOCRUZ/Federal University of Mato Grosso do Sul, Campo Grande; Daniela Riva Knauth and Andréa Fachel Leal, Universidade Federal do Rio Grande do Sul, Porto Alegre; Edgar Merchan-Hermann and Ximena Pamela Diaz, University of Brasília, Brasília; Luana N C Lima, Instituto Evandro Chagas, Belém; Maria Amélia Veras, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo; Maria Inês Dourado, Universidade Federal da Bahia, Salvador; Lígia Regina Franco Sansigolo Kerr (Project PI), Universidade Federal do Ceará, Fortaleza; Lisangela Cristina de Oliveira, Centro Universitário Autônomo do Brasil—UNIBRASIL, Curitiba; Mark Drew Crosland Guimarães, Universidade Federal de Minas Gerais, Belo Horizonte; Raimunda Hermelinda Maia Macena, Universidade Federal do Ceará, Fortaleza; Rosa Salani Mota, Universidade Federal do Ceará, Fortaleza; Maria do Socorro Cavalcante, Secretaria de Saúde do Ceará, Fortaleza; Carl Kendall, Tulane University, New Orleans and Universidade Federal do Ceará, Fortaleza; George Rutherford, University of California San Francisco, San Francisco; Willi McFarland, University of California San Francisco, San Francisco; Cristina Pimenta, Adele Schwartz Benzaken, and Gerson Pereira, from the DIAHV/MoH.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Joint United Nations Programme on HIV/AIDS. UNAIDS Data 2017. Geneva, Switzerland, 2017Google Scholar
  2. 2.
    Beyrer C, Baral SD, Van Griensven F, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.CrossRefGoogle Scholar
  3. 3.
    Kerr LRFS, Mota RS, Kendall C, et al. HIV among MSM in a large middle-income country. AIDS. 2013;27(3):427–35.CrossRefGoogle Scholar
  4. 4.
    Kerr L, Kendall C, Guimarães MDC, et al. HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore). 2018;97:S9–15.CrossRefGoogle Scholar
  5. 5.
    Kerr L, Guimarães M, Kendall C, et al. Increasing prevalence rate among MSM in Brazil: Results of a comparison of 2009 and 2016 national survey. XXII International AIDS Conference; Amsterdam; July 23–27, 2018 [Abstract 10183].Google Scholar
  6. 6.
    Balaji AB, Bowles KE, Le BC, Paz-Bailey G, Oster AM. High HIV incidence and prevalence and associated factors among young MSM, 2008. AIDS. 2013;27(2):269–78.CrossRefGoogle Scholar
  7. 7.
    Centers for Diseases Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths—United States. MMWR Morb Mortal Wkly Rep. 2012;61(47):971–6.Google Scholar
  8. 8.
    Wong VJ, Murray KR, Phelps BR, Vermund SH, McCarraher DR. Adolescents, young people, and the 90-90-90 goals: a call to improve HIV testing and linkage to treatment. AIDS. 2017;31(Suppl 3):S191–4.CrossRefGoogle Scholar
  9. 9.
    Brazil, Ministry of Health. Secretariat for Health Surveillance. Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis. Epidemiological Newsletter of IST/AIDS [Boletim Epidemiologico da DST/AIDS]. Brasília, Brazil, 2017.Google Scholar
  10. 10.
    Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.CrossRefGoogle Scholar
  11. 11.
    Fox J, Fidler S. Sexual transmission of HIV-1. Antiviral Res. 2010;85(1):276–85.CrossRefGoogle Scholar
  12. 12.
    Nelson KM, Gamarel KE, Pantalone DW, Carey MP, Simoni JM. Sexual debut and HIV-related sexual risk-taking by birth cohort among men who have sex with men in the United States. AIDS Behav. 2016;20(10):2286–95.CrossRefGoogle Scholar
  13. 13.
    Rocha GM, Kerr LRFS, Brito AM, Dourado I, Guimarães MDC. Unprotected receptive anal intercourse among men who have sex with men in Brazil. AIDS Behav. 2013;17(4):1288–95.CrossRefGoogle Scholar
  14. 14.
    Magno L, Dourado I, da Silva LAV, et al. Factors associated with self-reported discrimination against men who have sex with men in Brazil. Rev. Saúde Pública. 2017;51:102.CrossRefGoogle Scholar
  15. 15.
    Sullivan PS, Carballo-Dieguez A, Coates T, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380:388–99.CrossRefGoogle Scholar
  16. 16.
    Gomes RRFM, Ceccato MGB, Kerr LRFS, Guimaraes MDC. Factors associated with low knowledge on HIV/AIDS among men who have sex with men in Brazil. Cad Saude Publica. 2017;33(10):e00125515.CrossRefGoogle Scholar
  17. 17.
    Beyrer C, Sullivan P, Sanchez J, et al. The increase in global HIV epidemics in MSM. AIDS. 2013;27(17):2665–78.CrossRefGoogle Scholar
  18. 18.
    Chemnasiri T, Netwong T, Visarutratana S, et al. Inconsistent condom use among young men who have sex with men, male sex workers, and transgenders in Thailand. AIDS Educ Prev. 2010;22(2):100–9.CrossRefGoogle Scholar
  19. 19.
    Raifman J, Beyrer C, Arrington-Sanders R. HIV education and sexual risk behaviors among young men who have sex with men. LGBT Health. 2018;5(2):131–8.CrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report. 2018;23(1). Published March 2018.
  21. 21.
    Guimarães MDC, Kendall C, Magno L, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Medicine (Baltimore). 2018;97:S62–8.CrossRefGoogle Scholar
  22. 22.
    Joint United Nations Programme on HIV/AIDS. Global AIDS Monitoring 2018. Indicators for monitoring the 2016 United Nations Political Declaration on Ending AIDS. Geneva, Switzerland, 2018.Google Scholar
  23. 23.
    Kendall C, Kerr LRFS, Mota RS, et al. The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics. Braz J Epidemiol. 2018;97:S62–8.Google Scholar
  24. 24.
    Gomes RRFM, Batista JR, Ceccato MGB, Kerr LRFS, Guimarães MDC. HIV/AIDS knowledge among men who have sex with men in Brazil: applying the item response theory. Rev Saúde Pública. 2014;48:206–15.CrossRefGoogle Scholar
  25. 25.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRefGoogle Scholar
  26. 26.
    Gile KJ, Handcock MS. Respondent-driven sampling: an assessment of current methodology. Sociol Methodol. 2010;40(1):285–327.CrossRefGoogle Scholar
  27. 27.
    Handcock MS, Fellows IE, Gile KJ. RDS Analyst: software for the analysis of respondent-driven sampling data. Version 0.57, 2016.
  28. 28.
    Dennis AM, Simon EV, Frost DW. HIV-1 transmission clustering and phylodynamics highlight the important role of young men who have sex with men. AIDS Res Hum Retroviruses. 2018. Scholar
  29. 29.
    Jeffries WL, Greene KM, Paz-Bailey G, et al. Determinants of HIV incidence disparities among young and older men who have sex with men in the United States. AIDS Behav. 2018;22(7):2199–213.CrossRefGoogle Scholar
  30. 30.
    Mustanski BS, Newcomb ME, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–53.CrossRefGoogle Scholar
  31. 31.
    Brazil, Ministry of Health. Secretariat for Health Assistance. Department of Basic Assistance. Health on School Program [Programa Saúde na Escola] [Internet]. Brasília, Brazil: Ministry of Health. Secretariat for Health Assistance. 2017.
  32. 32.
    Doniec K, Dall’Alba R, King L. Austerity threatens universal health coverage in Brazil. The Lancet. 2016;388(10047):867–8.CrossRefGoogle Scholar
  33. 33.
    Doniec K, DallAlba R, King L. Brazil’s health catastrophe in the making. The Lancet. 2018;6736(18):5–6.Google Scholar
  34. 34.
    Interdisciplinar Brazilian AIDS Association. National AIDS Policy Observatory [Internet]. Rio de Janeiro, Brazil: Interdisciplinar Brazilian AIDS Association. 2018.
  35. 35.
    Basthi A, Parker R, Terto Jr V. Myth vs Reality: about the Brazilian answer to HIV/AIDS epidemic in 2016 [Mito vs Realidade: sobre a resposta brasileira à epidemia de HIV e AIDS em 2016]. Interdisciplinar Brazilian AIDS Association. 2016; 1–51.Google Scholar
  36. 36.
    Beyrer C, Malta M. The HIV epidemic and human rights violations in Brazil. J Int AIDS Soc. 2013;16:18817.CrossRefGoogle Scholar
  37. 37.
    Anema A, Marshall BDL, Stevenson B, et al. Intergenerational sex as a risk factor for HIV among young men who have sex with men: a scoping review. Curr HIV/AIDS Rep. 2013;10(4):398–407.CrossRefGoogle Scholar
  38. 38.
    Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. Prevalence of and factors associated with the use of HIV serosorting and other biomedical prevention strategies among men who have sex with men in a US Nationwide Survey. AIDS Behav. 2018;22(8):2743–55.CrossRefGoogle Scholar
  39. 39.
    Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30:597–605.CrossRefGoogle Scholar
  40. 40.
    Kendall C. The construction of risk in AIDS control programs: theoretical bases and popular Responses. In: Parker RGJ, editor. Conceiving Sexuality: approaches to sex research in a postmodern world. New York: Routledge; 1995. p. 249–58.Google Scholar
  41. 41.
    Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23:1153–62.CrossRefGoogle Scholar
  42. 42.
    Brazil, Ministry of Health. Secretariat for Health Surveillance. Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis. Clinical Protocol and Therapeutics Guidelines for Pre-Exposure Prophylaxis (PrEP) for HIV Infection [Protocolo Clínico e Diretrizes Terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV]. Brasília, Brazil, 2017.Google Scholar
  43. 43.
    Kendall C, Kerr LR, Gondim RC, et al. An empirical comparison of respondent-driven sampling, time location sampling, and snowball sampling for behavioral surveillance in men who have sex with men, Fortaleza, Brazil. AIDS Behav. 2008;12(Suppl 4):S97–104.CrossRefGoogle Scholar
  44. 44.
    Szwarcwald CL, Souza PRB Jr, Damacena GN, Barbosa A Jr, Kendall C. Analysis of data collected by RDS among sex workers in 10 Brazilian cities, 2009: estimation of the prevalence of HIV, variance, and design effect. J Acquir Immune Defic Syndr. 2011;57(Suppl. 3):S129–35.CrossRefGoogle Scholar
  45. 45.
    Parker R. Interdisciplinary Brazilian AIDS Association. The end of AIDS? [O Fim da AIDS?] [Internet]. Rio de Janeiro, Brazil: Interdisciplinary Brazilian AIDS Association. 2015.
  46. 46.
    Parker RG, Perez-Brumer A, Garcia J, et al. Prevention literacy: community-based advocacy for access and ownership of the HIV prevention toolkit. J Int AIDS Soc. 2016;19(1):21092.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Gustavo Machado Rocha
    • 1
    Email author
  • Mark Drew Crosland Guimarães
    • 2
  • Ana Maria de Brito
    • 3
  • Ines Dourado
    • 4
  • Maria Amélia Veras
    • 5
  • Laio Magno
    • 6
  • Carl Kendall
    • 7
    • 8
  • Ligia Regina Franco Sansigolo Kerr
    • 8
  • The Brazilian HIV/MSM Group
  1. 1.Federal University of São João del-ReiDivinópolisBrazil
  2. 2.Department of Preventive and Social MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  3. 3.Aggeu Magalhães Institute - FIOCRUZRecifeBrazil
  4. 4.Collective Health InstituteFederal University of BahiaSalvadorBrazil
  5. 5.Faculdade de Ciências Médicas da Santa Casa de São PauloSão PauloBrazil
  6. 6.Department of Life SciencesState University of BahiaSalvadorBrazil
  7. 7.Center for Global Health EquityTulane School of Public Health and Tropical MedicineNew OrleansUSA
  8. 8.Department of Community HealthFederal University of CearáFortalezaBrazil

Personalised recommendations