Revista de saude publica最新文献

{"title":"Prevalence of hepatitis among young men who have sex with men and transgender women in Brazil.","authors":"Carina Carvalho Dos Santos, Beo Oliveira Leite, Fernanda Washington de Mendonça Lima, Laio Magno, Alexandre Grangeiro, Mateus Westin, Daniel Lima de Moura, Inês Dourado","doi":"10.11606/s1518-8787.2020054005555","DOIUrl":"10.11606/s1518-8787.2020054005555","url":null,"abstract":"<p><strong>Objective: </strong>Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities.</p><p><strong>Methods: </strong>Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured.</p><p><strong>Results: </strong>The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B.</p><p><strong>Conclusions: </strong>The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"4s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent HIV infections and estimated HIV incidence among adolescents from key populations.","authors":"Diana Zeballos, Fabiane Soares, Laio Magno, Celia Landmann Szwarcwald, Orlando Ferreira, Mateus Westin, Dirceu Greco, Alexandre Grangeiro, Inês Dourado","doi":"10.11606/s1518-8787.2020054005997","DOIUrl":"10.11606/s1518-8787.2020054005997","url":null,"abstract":"<p><strong>Objective: </strong>To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil.</p><p><strong>Methods: </strong>From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15-19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02.</p><p><strong>Results: </strong>Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18-19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%.</p><p><strong>Conclusions: </strong>The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"3s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk and pleasure in the era of pharmacologically safe sex.","authors":"Filipe Mateus Duarte, Sandra Assis Brasil, Mônica Lima, Jardel da Silva Vidal, Laio Magno, Inês Dourado, Luís Augusto Vasconcelos da Silva","doi":"10.11606/s1518-8787.2024058005962","DOIUrl":"10.11606/s1518-8787.2024058005962","url":null,"abstract":"<p><strong>Objective: </strong>This article discusses how Pre-Exposure Prophylaxis (PrEP) and the undetectable viral load=untransmissible (UVL=U) have produced reconfigurations in the contexts of affective-sexual encounters of young gay men/men who have sex with men (MSM) living with HIV (YLHIV).</p><p><strong>Methods: </strong>In-depth interviews were conducted with nine YLHIV, aged 18 to 29, from two studies conducted in Salvador, Bahia, in 2019 and 2021. The narratives focused on unprecedented events in the prevention and treatment of HIV/AIDS, which have allowed experiences of greater intimacy and safety but also challenges and tensions in affective-sexual relationships.</p><p><strong>Results: </strong>Different moments in the experience of living with HIV reveal different narratives of YLHIV concerning the new PrEP and UVL biotechnologies. Concerns surrounding possible HIV transmission or the obligation to reveal serology are more prominent among young people with the most recent diagnosis. In contrast, those with more extended serology experience are more comfortable and confident in the face of new technologies and their significant effects on sexual encounters. However, controversies remain regarding the moral and behavioral consequences of their use. Some YLHIV re-update concerns and bring reports about the continuity of stigma toward people living with HIV. Others emphasize the benefits of biomedical advances, opening up new interactive possibilities, including without the use of condoms, highlighting the existence of other practices, knowledge, dynamics, and ways of negotiating risk/care, with tensions in the field of sexuality itself.</p><p><strong>Conclusions: </strong>We reiterate the need to resume public policies in the field of HIV/AIDS beyond biomedical strategies, highlighting vulnerabilities, the dissemination of information about new HIV prevention and treatment technologies, respect for people's autonomy in their preventive choices, and the development of strategies to combat the stigma associated with HIV/AIDS.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"7s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with condomless anal sex among adolescent men who have sex with men and transgender women in three Brazilian state capitals: a PrEP1519 study.","authors":"Rijone Rosário, Inês Dourado, Marcos Pereira, Lorenza Dezanet, Dirceu Greco, Alexandre Grangeiro, Laio Magno","doi":"10.11606/s1518-8787.2020054005462","DOIUrl":"10.11606/s1518-8787.2020054005462","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the factors that increase the practice of condomless anal sex (CAS) among adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW) in three Brazilian state capitals.</p><p><strong>Methods: </strong>PrEP1519 is a prospective, multicenter cohort study demonstrating the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among AMSM and ATGW aged from 15 to 19 years in three Brazilian state capitals. The analyses were performed with baseline cohort data, including 1,418 adolescents enrolled from 2019 to 2021. The outcome studied was CAS in the last six months, and the potentially associated factors were sociodemographic, behavioral, healthcare, and history of violence and discrimination. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95%CI) were estimated.</p><p><strong>Results: </strong>Most of the participants were AMSM (91.5%), aged 18 to 19 years (75.9%), Black (40.5%), with secondary or higher education in progress (92.7%), with CAS during the first sexual intercourse (54.2%), sexual initiation before the age of 14 (43.4%), and history of group sex (24.6%) and transactional sex (14.6%). The prevalence of CAS in the last six months was 80.6% (95%CI 78.5%-82.6%). Adolescents who reported condomless first sexual intercourse (aPR: 1.18; 95%CI 1.10-1.25), use of psychoactive substances (aPR: 1.09; 95%CI 1.03-1.16), and transactional sex (aPR: 1.11; 95%CI 1.04-1.20) had a higher prevalence of CAS in the last six months. We also found that those aged 15 to 17 years had a higher prevalence of CAS than those aged 18 to 19 (aPR: 1.07; 95%CI 0.99-1.13).</p><p><strong>Conclusions: </strong>The prevalence of CAS was high among AMSM and ATGW, being associated with practices that may increase the risk of sexually transmitted infections (STIs). Therefore, it is recommended to strengthen sexual health programs for young people that address the issue of sexuality and STI prevention, as well as to expand access to preventive methods, such as condoms and PrEP.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"8s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prep provision in community organizations: a comparative study with conventional services.","authors":"Alexandre Grangeiro, Paula Andrea Massa, Maria Mercedes Escuder, Eliana Miura Zucchi, Eliane Aparecida Sala, Eduardo Araujo de Oliveira, Raphaela Fini, Inês Dourado, Laio Magno, Beo Oliveira Leite, Katia Bruxvoort, Sarah MacCarthy, Marcia Thereza Couto, Maria Fernanda Tourinho Peres","doi":"10.11606/s1518-8787.2024058005914","DOIUrl":"10.11606/s1518-8787.2024058005914","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis.</p><p><strong>Methods: </strong>A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression.</p><p><strong>Results: </strong>608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV.</p><p><strong>Conclusion: </strong>The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"9s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamics of HIV self-testing uptake among sexual and gender minorities: pre and during COVID-19.","authors":"Laio Magno, Dulce Ferraz, Eliana Miura Zucchi, Jony Arrais Junior Pinto, Fabiane Soares, Alexandre Grangeiro, Dirceu Greco, Ines Dourado","doi":"10.11606/s1518-8787.2024058006011","DOIUrl":"10.11606/s1518-8787.2024058006011","url":null,"abstract":"<p><strong>Objective: </strong>To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals.</p><p><strong>Results: </strong>The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18-19 years and in participants who lived alone.</p><p><strong>Conclusions: </strong>Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"14s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gay and bisexual adolescents and other men who have sex with men: intersectionality and the PrEP care continuum.","authors":"Eduardo Araújo de Oliveira, Lorruan Alves Dos Santos, Eliana Miura Zucchi, Paula Massa, Alexandre Grangeiro, Marcia Thereza Couto","doi":"10.11606/s1518-8787.2024058005705","DOIUrl":"10.11606/s1518-8787.2024058005705","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the impact of intersecting systems of oppression on the continuum of PrEP care among adolescent gays, bisexuals, and other men who have sex with men (aGBMSM), and to examine how health professionals (HP) identify and address these challenges to provide sexual health care and HIV prevention.</p><p><strong>Methods: </strong>This qualitative exploratory study was part of a cohort research project involving aGBMSM, travesties, and transgender women (aTrTW) using PrEP. Data analyzed consisted of 16 interviews with aGBMSM and eight with health professionals (HPs) in São Paulo study site. The methodological and theoretical framework for the interactive categorization of thematic analysis was based on an intersectional approach.</p><p><strong>Results: </strong>The knowledge of aGBMSM about PrEP was influenced by the adverse effects of systems of oppression, particularly among Black adolescents, who acquired knowledge in a less technical manner compared to White adolescents. Most professionals recognized oppression and its impact on the PrEP care continuum (PrEPCC), especially noting the presence of racism. However, few articulated how different social markers compound barriers to the success of the PrEPCC.</p><p><strong>Conclusion: </strong>Social oppression affects the success of the PrEP care continuum (PrEPCC) in multiple ways. Health professionals (HPs) play a crucial role in mitigating and not perpetuating these negative experiences within health services, as well as in PrEP access, use, and adherence.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"11s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV prevention among marginalized adolescents: PrEP1519 results and perspectives.","authors":"João Luiz Bastos, Tonantzin Ribeiro Gonçalves, Eliseu Alves Waldman","doi":"10.11606/s1518-8787.2024058supl1ed","DOIUrl":"10.11606/s1518-8787.2024058supl1ed","url":null,"abstract":"","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"1s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New horizons in sexual health: exploring PrEP and HIV incidence in adolescents.","authors":"Alexandre Grangeiro, Eliane Miura Zucchi, Laio Magno, Unai Tupinambás, Dirceu Bartolomeu Greco, Inês Dourado","doi":"10.11606/s1518-8787.2024058supl1ap","DOIUrl":"10.11606/s1518-8787.2024058supl1ap","url":null,"abstract":"","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"2s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans/Travesti/+: PrEP in specialized services before and during the COVID-19 pandemic.","authors":"Ramiro Andres Fernandez Unsain, Eliana Miura Zucchi, Lorruan Alves Dos Santos, Dulce Ferraz, Paula Massa, Júlia Clara de Pontes, Alexandre Grangeiro, Marcia Thereza Couto","doi":"10.11606/s1518-8787.2024058005719","DOIUrl":"10.11606/s1518-8787.2024058005719","url":null,"abstract":"<p><strong>Objective: </strong>To understand the perceptions and experiences of transsexual and travesti women and non-binary or gender-fluid people (TGWT+) in health services where they took pre-exposure prophylaxis (PrEP) in the periods before and during the pandemic, focusing on the resignification in the relationship with services and the continuity of HIV prevention via PrEP.</p><p><strong>Methods: </strong>Qualitative research and analysis of empirical material generated in the context of broader studies were conducted. A total of 45 semi-structured interviews were conducted with TGWT+ PrEP users in the city of São Paulo and analyzed using iterative thematic content analysis.</p><p><strong>Results: </strong>The TGWT+ interviewees gave new meanings to their struggles, daily lives and ways of caring for their health and played a central role within them. With its particularities, the COVID-19 pandemic became one more event among all the others that TGWT+ face daily. Alongside the COVID-19 pandemic, the TGWT+ were faced with the HIV epidemic, but with the possibility of prevention via PrEP.</p><p><strong>Conclusion: </strong>Based on a situated and conscious perspective, more explicit in the context of the health crisis, the TGWT+ intertwined conscious actions and care practices in dialog with health services. Further research on these groups from a spatiotemporal dynamic situated in specific contexts of meaning production would make it possible to advance prevention and care strategies, especially in times of health crisis.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"12s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}