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


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.


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.

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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.

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Correspondence to Gustavo Machado Rocha.

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The members of the Brazilian HIV/MSM Group are listed in Acknowledgements section

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Rocha, G.M., Guimarães, M.D.C., de Brito, A.M. et al. High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil. AIDS Behav 24, 938–950 (2020). https://doi.org/10.1007/s10461-019-02459-y

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  • Risk behavior
  • Behavior surveillance
  • MSM
  • Brazil