Determinants of sexual exposure to HIV in Portuguese and Brazilian adolescents: a path analysis

Teixeira, Jules Ramon Brito; Lima, Shirley Veronica Melo Almeida; Sousa, Anderson Reis de; Queiroz, Artur Acelino Francisco Luz Nunes; Barreto, Nilo Manoel Pereira Vieira; Mendes, Isabel Amélia Costa; Fronteira, Inês; Sousa, Álvaro Francisco Lopes de

doi:10.1590/1518-8345.6222.3714

Jules Ramon Brito Teixeira

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Universidade Estadual de Feira de Santana, Departamento de Saúde Coletiva, Feira de Santana, BA, Brazil.

Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

http://orcid.org/0000-0002-8443-7810

Shirley Veronica Melo Almeida Lima

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Universidade Federal de Sergipe, Departamento de Enfermagem, Lagarto, SE, Brazil.

http://orcid.org/0000-0002-9062-0742

Anderson Reis de Sousa

obtaining data

data analysis and interpretation

drafting the manuscript

critical review

text approvement

Universidade Federal da Bahia, Departamento de Enfermagem, Feira de Santana, BA, Brazil.

http://orcid.org/0000-0001-8534-1960

Artur Acelino Francisco Luz Nunes Queiroz

study concept and design

obtaining data

data analysis and interpretation

drafting the manuscript

critical review

text approvement

Northwestern University, Institute for Sexual and Gender Minority Health and Well-being, Chicago, IL, United Steates of America.

http://orcid.org/0000-0002-6350-1908

Nilo Manoel Pereira Vieira Barreto

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Universidade Federal da Bahia, Departamento de Enfermagem, Feira de Santana, BA, Brazil.

http://orcid.org/0000-0002-1397-1362

Isabel Amélia Costa Mendes

study concept and design

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0002-0704-4319

Inês Fronteira

study concept and design

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, LX, Portugal.

http://orcid.org/0000-0003-1406-4585

Álvaro Francisco Lopes de Sousa

study concept and design

obtaining data

data analysis and interpretation

statistical analysis

drafting the manuscript

critical review

text approvement

Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, LX, Portugal.

Centro Universitário UNINOVAFAPI, Teresina, PI, Brazil.

http://orcid.org/0000-0003-2710-2122

Corresponding author: Álvaro Francisco Lopes de Sousa E-mail: sousa.alvaromd@gmail.com https://orcid.org/0000-0003-2710-2122

Associate Editor: Ricardo Alexandre Arcêncio

Conflict of interest: the authors have declared that there is no conflict of interest.

Universidade Estadual de Feira de Santana, Departamento de Saúde Coletiva, Feira de Santana, BA, Brazil.

Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

Universidade Federal de Sergipe, Departamento de Enfermagem, Lagarto, SE, Brazil.

Universidade Federal da Bahia, Departamento de Enfermagem, Feira de Santana, BA, Brazil.

Northwestern University, Institute for Sexual and Gender Minority Health and Well-being, Chicago, IL, United Steates of America.

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, LX, Portugal.

Centro Universitário UNINOVAFAPI, Teresina, PI, Brazil.

Variables	n	%	*95%CI
Age
18	303	52.4	48.3-56.6
19	275	47.6	43.4-51.7
Sex assigned at birth (n=577)
Male	557	96.5	94.7-97.9
Female	20	3.5	2.1-5.3
Education
Primary	8	1.4	0.6-2.7
Secondary	217	37.5	33.6-41.6
Attending tertiary	353	61.1	57.0-65.1
Country of birth
Brazil	367	63.5	59.4-67.4
Portugal	202	34.9	31.1-39.0
Mozambique	4	0.7	0.2-1.8
Guinea Bissau	4	0.7	0.2-1.8
Cape Verde	1	0.2	0.004-0.10
Country of residence
Brazil	291	50.3	46.2-54.5
Portugal	287	49.7	45.5-53.8
Relationship status
Single	401	69.4	65.4-73.1
Steady relationship	149	25.8	22.2-29.5
Polyamorous relationship	28	4.8	3.2-6.9
Sexual partner
Casual/occasional partner	403	69.7	65.8-73.4
Steady/usual partner	28	4.8	3.2-6.9
Steady partner and occasional partners	147	25.4	21.9-29.2
Number of partners in the last 30 days
None	97	16.8	13.8-20.1
1 to 2	309	53.5	49.3-57.6
3 or more	172	29.8	26.1-33.7
Sexual position of preference
Oral sex only	21	3.6	2.26-5.50
Penetrating/top - exclusively	51	8.8	66-11.4
Penetrating/top - mostly	101	17.5	14.5-20.8
Being penetrated/bottom - exclusively	68	11.8	9.3-14.7
Being penetrated/bottom - mostly	111	19.2	16.1-22.7
Penetrating and being penetrated (versatile) alike	226	39.1	35.1-43.2
Chemsex practice
No	400	69.2	65.3-72.9
Yes	178	30.8	27.1-34.7
Use of apps^† ^†
No	104	18.0	14.9-21.4
Yes	474	82.0	78.6-85.1
Sexual partners found through apps
No	108	18.7	15.6-22.1
Yes	470	81.3	77.9-84.4

Variables	n	%	*95%CI
Unawareness (is unaware)
Is it possible to prevent HIV^† infection by taking PrEP^‡ daily	66	11.4	8.9-14.3
PEP^§ taken after sexual exposure can stop HIV^† infection	190	32.9	29.1-36.9
People with HIV^† with undetected viral load for at least 6 months do not transmit the virus	140	24.2	20.8-27.9
Partner credibility
Partner using PrEP^‡	57	9.9	7.6-12.6
Known/repeated partner	155	26.8	23.2-30.6
Partner claims not to have STD^\|\|	60	10.4	8.0-13.2
Partner claims being recently tested	41	7.1	5.1-9.5
Challenging sexual practices
Cruising	23	4.0	2.5-5.9
Double penetration	155	26.8	23.2-30.6
Fisting	60	10.4	8.0-13.2
Ineffective forms of protection
Coitus interruptus	155	26.8	23.2-30.6
Only penetrates	32	5.5	3.8-7.7
Does not use any form of prevention	60	10.4	8.0-13.2
Tests self or partners before sex	127	22.0	18.7-25.6
Keeps viral load low	34	5.9	4.1-8.1

Paths	Standardized coefficient	p-value
Total effects
APP*→EXP^†	-0.273	0.011
CHEM^‡→EXP^†	0.285	<0.001
DES^§→EXP^†	0.049	0.449
PSD^\|\|→EXP^†	0.481	0.001
MPE^¶→EXP^†	0.347	0.038
CRED**→EXP^†	0.222	0.003
CONJ^††→EXP^†	-0.038	0.536
Specific indirect effects
APP*
APP*→CHEM^‡→EXP^†	-0.009	0.553
APP*→DES^§→EXP^†	-0.001	0.696
APP*→MPE^¶→EXP^†	-0.001	0.972
APP*→DES^§→CHEM^‡→EXP^†	0.000	0.790
APP*→CHEM^‡→PSD^\|\|→EXP^†	0.031	0.225
APP*→DES^§→PSD^\|\|→EXP^†	-0.001	0.699
APP*→CHEM^‡→MPE^¶→EXP^†	0.006	0.391
APP*→DES^§→MPE^¶→EXP^†	0.000	0.693
APP→DES^§→CRED*→EXP^†	0.000	0.828
APP→DES^§→CRED*→CHEM^‡→EXP^†	0.000	0.832
APP*→DES^§→CHEM^‡→PSD^\|\|→EXP^†	0.000	0.770
APP→DES^§→CRED*→PSD^\|\|→EXP^†	0.000	0.871
APP*→DES^§→CHEM^‡→MPE^¶→EXP^†	0.000	0.776
APP*→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.891
APP*→DES^§→PSD^\|\|→MPE^¶→EXP^†	0.000	0.900
APP→DES^§→CRED*→MPE^¶→EXP^†	0.000	0.820
APP→DES^§→CRED*→CHEM^‡→PSD^\|\|→EXP^†	0.000	0.821
APP→DES^§→CRED*→CHEM^‡→MPE→EXP^†	0.000	0.823
APP*→DES^§→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.901
APP→DES^§→CRED*→PSD^\|\|→MPE^¶→EXP^†	0.000	0.906
APP→DES^§→CRED*→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.909
CONJ ^††
CONJ^††→APP*→EXP^†	0.136	0.010
CONJ^††→MPE^¶→EXP^†	-0.003	0.888
CONJ^††→APP*→CHEM^‡→EXP^†	0.004	0.552
CONJ^††→APP*→DES^§→EXP^†	0.001	0.698
CONJ^††→APP*→MPE^¶→EXP^†	0.000	0.972
CONJ^††→APP*→DES^§→CHEM^‡→EXP^†	0.000	0.790
CONJ^††→APP*→CHEM^‡→PSD^\|\|→EXP^†	-0.014	0.225
CONJ^††→APP*→DES^§→PSD^\|\|→EXP^†	0.000	0.700
CONJ^††→APP*→CHEM^‡→MPE^¶→EXP^†	-0.003	0.389
CONJ^††→APP*→DES^§→MPE^¶→EXP^†	0.000	0.693
CONJ^††→APP→DES^§→CRED*→EXP^†	0.000	0.829
CONJ^††→APP→DES^§→CRED*→CHEM^‡→EXP^†	0.000	0.832
CONJ^††→APP*→DES^§→CHEM^‡→PSD^\|\|→EXP^†	0.000	0.771
CONJ^††→APP→DES^§→CRED*→PSD^\|\|→EXP^†	0.000	0.871
CONJ^††→APP*→DES^§→CHEM^‡→MPE^¶→EXP^†	0.000	0.776
CONJ^††→APP*→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.891
CONJ^††→APP*→DES^§→PSD^\|\|→MPE^¶→EXP^†	0.000	0.900
CONJ^††→APP→DES^§→CRED*→MPE^¶→EXP^†	0.000	0.821
CONJ^††→APP→DES^§→CRED*→CHEM^‡→PSD^\|\|→EXP^†	0.000	0.821
CONJ^††→APP→DES^§→CRED*→CHEM^‡→MPE^¶→EXP^†	0.000	0.824
CONJ^††→APP*→DES^§→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.901
CONJ^††→APP→DES^§→CRED*→PSD^\|\|→MPE^¶→EXP^†	0.000	0.907
CONJ^††→APP→DES^§→CRED*→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.909
CHEM ^‡
CHEM^‡→PSD^\|\|→EXP^†	0.321	0.002
CHEM^‡→MPE^¶→EXP^†	0.058	0.244
CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.003	0.891
DES ^§
DES^§→CHEM^‡→EXP^†	-0.002	0.736
DES^§→PSD^\|\|→EXP^†	0.020	0.473
DES^§→MPE^¶→EXP^†	-0.017	0.410
DES^§→CRED**→EXP^†	0.001	0.815
DES^§→CRED**→CHEM^‡→EXP^†	0.000	0.819
DES^§→CHEM^‡→PSD^\|\|→EXP^†	0.008	0.691
DES^§→CRED**→PSD^\|\|→EXP^†	0.000	0.866
DES^§→CHEM^‡→MPE^¶→EXP^†	0.001	0.706
DES^§→PSD^\|\|→MPE^¶→EXP^†	0.000	0.894
DES^§→CRED**→MPE^¶→EXP^†	-0.004	0.804
DES^§→CRED**→CHEM^‡→PSD^\|\|→EXP^†	-0.001	0.804
DES^§→CRED**→CHEM^‡→MPE^¶→EXP^†	0.000	0.808
DES^§→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.894
DES^§→CRED**→PSD^\|\|→MPE^¶→EXP^†	0.000	0.903
DES^§→CRED**→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.905
CRED**
CRED**→CHEM^‡→EXP^†	-0.014	0.551
CRED**→PSD^\|\|→EXP^†	0.007	0.813
CRED**→MPE^¶→EXP^†	0.268	0.040
CRED**→CHEM^‡→PSD^\|\|→EXP^†	0.046	0.094
CRED**→CHEM^‡→MPE^¶→EXP^†	0.008	0.259
CRED**→PSD^\|\|→MPE^¶→EXP^†	0.000	0.887
CRED**→CHEM^‡→PSD^\|\|→MPE^¶→EXP^†	0.000	0.891
PSD ^\|\|
PSD^\|\|→MPE^¶→EXP^†	0.005	0.891

[1] Corresponding author: Álvaro Francisco Lopes de Sousa E-mail: sousa.alvaromd@gmail.com https://orcid.org/0000-0003-2710-2122

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Abstract

Objective:

Method:

Results:

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Highlights: