Mental health aspects and substance use can affect adherence to pre-exposure prophylaxis (PrEP) for HIV, thus increasing vulnerability to infection with the virus. Long-term PrEP strategies have demonstrated high efficacy and may be useful in contexts marked by adherence barriers, such as stigma and discrimination in health services.

A study conducted by Carolina Coutinho, from the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, in Rio de Janeiro, and the ImPrEP CAB Brazil Study Group*, described the prevalence of substance use, chemsex (use of chemical substances for sexual purposes), depressive symptoms, and suicidal ideation among young people from sexual and gender minorities in Brazil. The study was presented at the 14th Congress of the Brazilian Association of Collective Health (Abrasco), held from November 28 to December 3 in Brasília.

The ImPrEP CAB Brasil study was an implementation study of long-acting injectable PrEP based on cabotegravir (CAB-LA) among young people from sexual and gender minorities, aged 18 to 30, who sought prophylaxis in public services in six Brazilian cities (Manaus, Salvador, Rio de Janeiro, Florianópolis, São Paulo, and Campinas), from October 2023 to September 2024. In this analysis, the researchers examined the results of the inclusion visits of those who started prophylaxis with CAB-LA injections.

1,200 young people from sexual and gender minorities were included, of whom 62% were aged 25 to 30, with 91% being gay, bisexual, and other men who have sex with men (MSM) and 61% being Black/mixed-race. More than three-quarters (76%) reported engaging in binge drinking (excessive alcohol use in a short period), 28% said they used at least one substance, and 13% reported engaging in chemsex in the previous six months.

In total, 11% presented moderate/severe depression and 10% reported a risk of suicide. Depression was more prevalent among people with lower levels of education and more reports of substance use, as well as sex workers. The risk of suicide was higher among young people aged 18 to 20.

The authors reinforce the need for integration between PrEP and sexual health services with mental health care. They emphasize the importance of articulating strategies for harm reduction in people who use substances, with long-acting injectable PrEP being a key ally in promoting greater equity in HIV prevention.

*Authors:

Carolina Coutinho (1), Mayara Secco (1), Thiago Torres (1), Brenda Hoagland (1), Davi Coelho (1), Marcos Benedetti (1), Ronaldo Ismério (1), Valdiléa Veloso (1), Beatriz Grinsztejn (1) and ImPrEP CAB Brazil Study Group

(1) Evandro Chagas National Institute of Infectology, Fiocruz, Rio de Janeiro, Brazil.