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Epidemiological studies on such issues are essential for adequate surveillance of the AIDS epidemic, since surveillance of HIV alone is known to be insufficient to provide information for planning preventive measures 5.
This type of follow-up is known as second-generation HIV surveillance 8, This monitoring strategy is capable of gathering important information on the diversity of behaviors and sexual practices among MSM and other potentially hidden or hard-to-reach populations 18, The surveys presented here summarize some of the main problems in studies targeting hard-to-reach populations, and there is generally no single solution, since comparisons with results obtained using an ideal selection process e.
There is extensive international literature using these different types of sampling, and the vast majority use analytical procedures as if these processes were derived from random samples. In the years preceding , the same approach was taken to the samples, regardless of the sampling technique used.
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The majority of the studies using TSS were non-weighted, and there is still considerable debate over the most appropriate methods for weighting and adjusting the samples obtained via TSS and RDS. Sequential studies of MSM are still quite scarce in Brazil and even in the international setting. Most of the existing studies used other sampling techniques cited in this study until , when the RDS methodology began to be used in the country and was recommended by the Ministry of Health as the method of choice for hard-to-reach populations in general.
In , when TSS was used, there was little experience in Brazil on the weighting used to analyze data collected with this technique. Although participants in the study were selected randomly, it was not possible to weight them, since the data were lost on the total number of individuals from which the sample was extracted. Thus, while recognizing the limitation of the processes used in this study, there is no other study like it in Brazil.
The results of the current study should be interpreted in light of the familiar limitations of non-probabilistic selection procedures and particularly the use of different methodologies from one study year to the next. One must consider the possibility that these characteristics accounted at least partially for the time trends indicated here.
However, a study comparing populations recruited with the different methodologies showed that the participants are distributed in different proportions in the social classes, leading to over-representation of higher-income individuals with the TSS and snowball techniques and their under-representation in RDS Thus, the decrease in risky behavior observed in would gain even more validity, given the greater participation by lower-income social classes, which usually show higher rates of risky behavior.
Please contribute and help us make it a star! Heavy funding constraints for AIDS prevention in Brazil since several international agencies have curtailed their cooperation in the country and focused elsewhere e. Luthar et al. There is usually a breeze blowing from the east softening the temperature and forming the sand dunes. Hotel Beira Mar. The items were in the affirmative form and measured on a 5-point Likert scale, from 0 - totally disagree to 4 - strongly agree. Beautiful venue.
Brazil demonstrates a high degree of geographic, social, economic and cultural heterogeneity, and local policies need to take this into account. This is true both at the government level and in the development of civil society organizations involved in the response to AIDS Thus, when studying risky sexual behaviors, some important issues should be considered, especially the fact that subjective characteristics are involved in the problem. In this sense, there is an evident need to understand the sexual values in Brazilian culture in general, and more specifically in the homosexual subcultures, considering the subjective aspects related to erotic pleasure and sexual satisfaction, which are associated with risky behaviors and the difficulties in changing them, regardless of the population's knowledge of risky practices Thus, prevention and intervention activities are needed that extend beyond supplying information.
These interventions need to understand and address the more complex social and psychological issues associated with risky sexual practices, since the adoption of safer practices is not necessarily related to the level of knowledge about them.
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Gondim participated in the elaboration of the projects in the different years, the fieldwork from to , data analysis, and writing of the article. Kerr contributed to the elaboration of the projects in the different years, the data analysis, and writing of the article. Werneck contributed to the data analysis and writing and revision of the article. Macena and M. Pontes collaborated in the fieldwork in , the data analysis, and writing of the article. Kendall participated in the data analysis and writing of the article.
Rev Soc Bras Med Trop ; Almeida RLC. Increases in HIV-related sexual risk behavior among community samples of gay men in London and Glasgow: how do they compare? J Acquir Immune Defic Syndr ; Henry K. BSS: Tracking trends in sexual behavior. Aidscaptions ; Second generation HIV surveillance: better data for decision-making. Bull World Health Organ ; HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups. HIV risk behavioral surveillance: a methodology for monitoring behavioral trends.
Changes in the transmission dynamics of the HIV epidemic after the wide-scale use of antiretroviral therapy could explain increases in sexually transmitted infections: results from mathematical models. Sex Transm Dis ; Evaluation of the Centers for Disease Control and Prevention's HIV behavioral surveillance of men who have sex with men: sampling issues. Martin JL. AIDS risk reduction recommendations and sexual behavior patterns among gay men: a multifactorial categorical approach to assessing change. Health Educ Q ; The feasibility of integrated STI prevalence and behaviour surveys in developing countries.
Sex Transm Infect ; Biernacki P, Waldorf D. Snowball sampling. Problems and techniques of chain referral sampling. Sociol Methods Res ; Erickson BH. Some problems of inference from chain data. Sociol Methodol ; A venue-based method for sampling hard-to-reach populations.
Public Health Rep ; Suppl Time-space sampling in minority communities: results with young Latino men who have sex with men. Am J Public Health ; Review of sampling hard-to-reach and hidden populations for HIV surveillance.
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Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Social Problems ; From networks to populations: the development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS Behav ; Sociodemographic Questionnaire : Specially designed for this study by the authors of this article, this instrument consists of 24 questions that seek to characterize the participants with sociodemographic variables age, sex, socioeconomic level, occupation, cohabitation, number of children, among others.
Items are measured on a 4-point Likert scale, from 0 - totally disagree to 3 - totally agree. For the analysis of the data, some items of the instrument were inverted so that the higher the levels of the scale, the greater the internalized homophobia. In the case of negative items e. In this sense, the responses of the negative items were reversed, the lowest score indicating the best level of psychological well-being. In a confirmatory factor analysis, the bi-directional model was re-specified using a second-order factor, with two correlations between measurement errors.
Such modifications enabled us to arrive at a one-way solution. After the confirmatory factorial analysis with the present sample, nine items of the instrument were eliminated and some of them were inverted so that the higher the scores obtained in the scale, the more satisfied people are in their marital relationship. Respondents were to score on a 4-point Likert scale from 0 - Strongly disagree to 3 - Strongly agree. The items were in the affirmative form and measured on a 5-point Likert scale, from 0 - totally disagree to 4 - strongly agree.
These are: fun, content, lively, harassed, humiliated, hurt, angry, and cheerful. Each adjective is evaluated by the participants on a five-point Likert scale from 0 - none to 4 - very much. Data collection.
When contacting participants, the snowball method was used, to identify other potential collaborators. The questionnaires were applied individually, and the participants took an average of 30 minutes to answer them.
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The collection took place from March to February Data analysis. Cluster analysis was used to group participants into different profiles that may be more or less indicative of the adaptive process among LG people. For the grouping, the first step was to select the characteristics that guide this classification.
From a range of 2 to 6, the chosen solution followed the criteria of smaller number of groups, associated with the greater increase of explained variance measured by changes in R 2. The study was approved by the Ethics Committee of the University where the authors research Opinion From the hierarchical analysis of clusters, the solution with four clusters proved to be more appropriate to group the cases, with These clusters are statistically different from each other, both concerning the risk and the indicators of psychosocial adjustment.
Table 1 presents the four profiles Poorly adapted, Competent, Resilient, and Vulnerable that emerged, as well as the ANOVA results for the risk and adjustment indicators of the four clusters. Table 1 Risk measures and indicators of cluster adaptation Note.
In turn, the lower the mean overall health, the lower the psychological discomfort. Despite the Resilient cluster pointing out that its participants experienced high-risk situations, the results show that the LG people of this group are positively adjusted both psychologically and relationally: they presented a low average of psychological discomfort that is, high general health and a relatively high level of marital satisfaction above the midpoint of the scale.
In contrast, cluster 2 leaves no doubt as to its classification as Vulnerable: it shared the highest level of risk, with the second highest value of psychological discomfort low overall health and the lowest level of marital satisfaction. The Poorly adapted group, associated with the lowest risk, presented the highest value of psychological discomfort an indicator of psychological adjustment and third lowest value of conjugal satisfaction relational adjustment indicator.
Profile 3, Competent, showed the lowest level of internal perception of stigma, associated with the lowest level of psychological discomfort and the highest of marital satisfaction, leaving no doubt that it would be categorized as the Competent group. Table 2 shows the percentages of sociodemographic characteristics of the participants in the four clusters.
Table 2 Percentages of sociodemographic characteristics in different adjustment profiles Notes.
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Based on the results of the chi-square test, the Resilient profile was predominantly gay, with more than five years of relationship and no religion. The Vulnerable group, in turn, presented a high number of participants with full secondary education, a job, and a relationship between 1 and 5 years. In this profile, none of the participants has more than 10 years of marital relationship. The Competent group, on the other hand, is formed mainly by lesbians, with no religion and mostly with undergraduate and graduate education. The Poorly adapted profile is predominantly composed of participants who do not work and do not have a religion.
In the classification of the adaptive profiles, the risk and psychological and relational adaptation indicators were considered.
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But do the indicators of protection also differ among groups, corroborating the literature on resilience? To answer this question, we investigated whether the LG profiles were differently related to the following variables: perception of social support friendship, intimacy, family, and social activities ; positive affection; and negative affection. Table 3 shows the differences between the four clusters.
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Table 3 Means between clusters and protection mechanisms Note. The Post Hoc LSD Test revealed that participants from the Resilient and Competent groups differed from the other groups and presented the highest means of protection, especially in support of friendship, intimacy, and social activities.
Vulnerable and Poorly adapted clusters, on the other hand, practically did not differed between themselves, obtaining the lowest averages in support of friendship, intimacy, family, and social activities and the highest means in negative affection. This study aimed to classify and characterize different profiles of psychosocial adjustment in LGB individuals.