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Risk Behaviors for Hiv Infection. a Review of Emerging Trends

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Risk Behaviors for Hiv Infection. a Review of Emerging Trends DOI: 10.1590/1413-81232018244.02322017 1417 Conductas de riesgo hacia la infección por VIH. REVIEW REVISÃO Una revisión de tendencias emergentes Risk behaviors for HIV infection. A review of emerging trends Yasel Manuel Santiesteban Díaz (https://orcid.org/0000-0003-2566-4789) 1 Solon Alberto Orlando-Narváez (https://orcid.org/0000-0002-5787-3115) 2 Rafael Ballester-Arnal (https://orcid.org/0000-0003-4421-1144) 3 Abstract HIV infection, acquired with the con- Resumen La infección por VIH, adquirida con scious participation of the recipient, is a com- participación consciente del receptor, es un pro- plex problem of international concern, especially blema complejo de alcance mundial, particular among men who have sex with men. Behaviors entre hombres que tienen sexo con otros hombres. emerge such as bareback (intentionally unprotect- Emergen comportamientos como el Bareback ed anal sex between men) and bugchasing (bare- (sexo anal sin protección de modo intencional en- back sex when one participant is HIV+ and the tre hombres) y, Bugchasing (sexo bareback cuando other is not). A group of emerging risk behaviors uno de los participantes es VIH+ y el otro no). Se for HIV infection was characterized. A review of caracterizó un grupo de conductas emergentes de the literature in the MEDLINE, Web of Science riesgo hacia la infección por VIH. Se realizó una and regional SciELO databases was performed. revisión bibliográfica en las bases de datos Medli- HIV-related search terms such as unprotected ne, Web of Sciences, y Scielo regional. Se utilizaron sex, barebacking/bareback and bug chasing, were términos de búsqueda como, sexo sin protección, used. Bareback and bug chaser behaviors occur, Barebacking/Bareback, y Bug chasing, todos rela- among other factors, through social homonega- cionados al VIH. Las conductas Barecack, y Bug tivity, ART positive coverage, insufficient preven- Chaser se producen entre otros factores por el Ho- tion campaigns, search for new sensations and monegativiso social, la cobertura positiva de la attempts to strengthen the relationship with the Terapia Antirretroviral, campañas de prevención HIV+ member. Unprotected sex is primarily asso- insuficientes, búsqueda de nuevas sensaciones, y el ciated with having HIV/AIDS diagnoses, physical intento de fortalecer la relación con un miembro violence due to sexual orientation, viewing homo- de la pareja VIH+. El sexo sin protección por su sexual sex sites, and having bought or sold sex. It is parte se asocia principalmente a tener diagnóstico necessary to work with individual behaviors that de VIH/sida, violencia física debido a la orienta- 1 Instituto Nacional de draw individuals close to infection. ción sexual, asistir a sitios de sexo Gay y haber Investigación en Salud Pública. Av. de las Américas. Key words HIV, Behavior, Bareback, Risk, Sex comprado o vendido sexo. Se debe trabajar con Guayaquil Ecuador. los comportamientos individuales que acercan al [email protected] sujeto a la infección. 2 Universidad Agraria del Ecuador. Guaiaquil Palabras clave HIV, Conductas, Bareback, Ries- Equador. go, Sexo 3 Universidad Jaume I. Castellón de la Plana Castellón Espanha. 1418 et al. Introducción ducta vulnerable, de modo que identifican tres tipos de comportamientos relacionados con la La epidemia del VIH/sida ha sido vista desde su infección por VIH: comportamientos que incre- Santiesteban Santiesteban Díaz YM dimensión social, económica, política y en su mentan la exposición al VIH, comportamientos relación con otras Infecciones de Transmisión que facilitan la infección por VIH y comporta- Sexual (ITS), sin embargo, aún quedan algunas mientos que proveen protección para la infección brechas en el conocimiento del papel del indivi- por VIH. Por tanto, se presume que existen com- duo como ser vulnerable de adquirir la infección, portamientos de riesgo que incrementan la pro- que pudieran resumirse en un proceso dinámico babilidad de adquirir la infección, y de protec- en el cual se involucran diferentes factores (socia- ción específicos que contrarrestan a los primeros les, ambientales y culturales)1 Hasta el momento y que pueden ser identificados para estudiarlos no se dispone de una vacuna o agente terapéutico como variables de medida del proceso de adqui- capaz de eliminar el VIH, por lo que la estrategia sición1. De aquellos que incrementan el riesgo, fundamental de respuesta es la prevención, enca- la participación del individuo vulnerable en la minada al trabajo sobre las formas de Transmi- dinámica de diseminación del virus adquiere sión y los grupos vulnerables. un valor considerable para el direccionamiento Las tendencias epidemiológicas desde media- de estrategias de prevención. El presente estudio dos de la década de 1990 sugieren un aumento pretende realizar una revisión bibliográfica con el alarmante de los comportamientos sexuales no fin de caracterizar algunas conductas emergentes protegidos entre los hombres que tienen relacio- de riesgo hacia la infección por VIH. nes sexuales con hombres (HSH), fenómeno que se daba principalmente en grandes comunidades homosexuales2,3. Estos datos documentan el au- Métodos mento gradual de las infecciones por VIH en esta población de la época4,5, especialmente entre los Se realizó una revisión Bibliográfica median- hombres jóvenes homosexuales y bisexuales6,7. te una búsqueda en las bases de datos Medline, En la actualidad estos comportamientos se Web of Sciences, y Scielo regional. Se utilizaron han diversificado y complejizado. Se observan términos de búsqueda como, sexo sin protección, conductas como el llamado Bareback 9 (reali- Barebacking/Bareback, y Bug chasing, todos rela- zación de sexo anal sin condón de modo inten- cionados con el VIH. Las búsquedas se hicieron cional entre hombres que no son pareja estable); en idioma español e idioma inglés y no se tuvo Bug chasing 10 (cazadores de virus) acto de llevar en cuenta una determinación por año para las a cabo sexo bareback cuando uno de los parti- pesquisas. Se escogieron solo los artículos don- cipantes presenta estatus serológico positivo y el de en su título se reflejaba uno de los términos otro no; y Gift giver 10 (el que ofrece el regalo) de búsqueda y que estuvieran disponibles a tex- (individuos con VIH positivo que se prestan a to completo. Para complementar este proceso, donar su virus a quien desee recibirlo). Aunque se inspeccionaron las listas de referencias de los medios periodísticos han llamado la atención artículos identificados. El principal criterio de acerca de algunas tendencias que desfavorecen inclusión fue un sustancial énfasis en conductas los esfuerzos por controlar la epidemia, estas de sexo desprotegido intencional relacionado de aún no han sido suficientemente abordadas por alguna manera con la infección por VIH. Se ex- estudios científicos. En todo problema de salud, cluyeron los resúmenes de congresos, las cartas al como lo es sin duda el VIH, es necesario estudiar editor y las revisiones de libros. cómo ocurre el proceso de transmisión de la en- fermedad. Varios modelos han sido desarrollados para explicar el contexto y las causas del VIH/ Resultados sida, así como para identificar los impactos de la epidemia y sus estrategias de control. El mode- Bajo los términos de búsqueda se encontraron lo propuesto por Coreil et al.8 desglosa los tres un total de 90 artículos. De ellos 62 se ubican en macro-ambientes donde se desenvuelven los de- el término sexo sin protección-VIH, 26 pertene- terminantes que influencian la vulnerabilidad de cen a los términos Barebacking/Bareback y por adquirir una enfermedad transmisible: ambiente último solo 2 responden a Bug chaser. A conti- social, ambiente biofísico y ambiente constituido nuación se describirán los resultados de la revi- sobre la base de la cultura. Gala González et al.1 sión de estos términos por separado. adaptan dicho modelo a la temática de la con- 1419 Ciência & Saúde Coletiva, 24(4):1417-1426, 2019 24(4):1417-1426, Coletiva, & Saúde Ciência Bareback HSH que reportan por internet realizar la prácti- ca del Bareback en todos los Estados Unidos28,31. El fenómeno del Barebacking ha sido exa- minado desde el perspectiva de la Sociología9-12, Factores asociados con el Barebacking Psicología13-17, y la Salud Pública16-23; entre otras ciencias. A pesar de las perspectivas dispares, la Varios autores han intentado explicar el fenó- mayoría de estos informes coinciden en abordar meno del Barebacking desde diferentes diseños las cuestiones de definición y factores que pue- metodológicos, población, y abordajes teóricos. den explicar la popularidad del sexo sin protec- Berg16 en un estudio de revisión sobre este fe- ción del tipo Barebacking. nómeno propone un modelo conceptual donde El término Bareback es una expresión ecues- refleja la dinámica de las relaciones que sirve de tre que significa montar a caballo sin montura. Es base para entender el Barebacking. Este autor introducido por primera vez fuera de los térmi- propone cuatro niveles en los cuales se desarrolla nos ecuestres por O’Hara24 en el año 1997. Más este comportamiento. adelante es definido por Goodroad et al.25 como la realización de sexo anal sin condón de modo Nivel macro intencional entre hombres que no son pareja es- table. El término bareback citando a Bazaldúa26 es Uno de los factores importantes que inciden también conocido como “sexo a pelo” o “sexo al en estas conductas es la ideología de los hetero- natural” y puede ser diferenciado de otras prácti- sexuales, la cual es restrictiva y alienante para los cas sexuales de riesgo por: 1) la intencionalidad y homosexuales. Esta serie de conceptos y creencias premeditación de llevar a cabo el acto sexual sin heterosexuales prepotentes han provocado de utilizar un método de barrera como es el condón alguna forma la aparición del llamado “Homo- en sus múltiples presentaciones; 2) enfocarse a negativismo” contribuyendo al rechazo social de prácticas de sexo anal entre hombres; 3) tener un los homosexuales como minorías. Algunos inves- referente temporal y cultural que se da después tigadores sociales32,33 enmarcan el Barebaking en de la aparición y propagación del VIH/Sida.
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