Infection caused by the Human Immunodeficiency Virus (HIV), more than three decades after notification of the first cases, remains a worldwide public health problem, despite all the advances achieved in the treatment and expansion of prevention strategies. It is estimated that approximately 37.9 million people were living with HIV worldwide by the end of 2018.
In 2018, approximately 44,000 new cases of HIV infection were reported in Brazil, of which 16,586 (37.7%) were in the Northeast region. From 1980 to June 2019, 966,058 AIDS cases were reported in Brazil; with regard to HIV cases (without AIDS), 300,496 were reported from 2007 to June 2019 . However, the epidemic disproportionately affects key populations in the country . The main route of HIV transmission is sexual, among people aged 13 and over. National statistics indicate that 78.9% were infected through unsafe sexual practices, with 86.9% among women.
Condom use was central as a method of prevention of sexual transmission of HIV widely recommended and widespread throughout the historical path of the epidemic . In fact, condoms have advantages in terms of low cost, easy access and low adverse effects when they are adopted consistently and correctly. In addition, they are effective in preventing other sexually transmitted infectionsand considered fundamental to a comprehensive approach to prevention .
However, this strategy does not eliminate the risk of HIV transmission. A systematic review study showed that the consistent use of condoms (for all acts of vaginal penetration) in heterosexual relationships results in an 80% reduction in the incidence of HIVand 70% among male homosexuals (for anal sex).In addition, studies have shown inconsistent condom use among partners living with HIV and relating to HIV-negative people or with unknown HIV status [4, 8].
Consistent condom use among people living with HIV (PLHIV) comes up against gender norms and psychosocial, cultural and relationship barriers that imply vulnerabilities for HIV-negative sexual partners.
Therefore, important advances in the field of HIV prevention have provided paradigm shifts with the implementation of combined biomedical, behavioral and structural interventions. Combined prevention is a broader concept that combines different prevention methods that can interfere with the sexual transmission of the virus, with the use of antiretrovirals, including Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), termed as biomedical interventions. Such strategies have been considered to be effective in reducing the risk of HIV transmission and are part of combined prevention.
PEP is a method used in situations where sexual exposure to HIV occurs, especially when the sexual act was performed in the absence of condoms, or in times of condom failures, such as breakage or problems with structural characteristics due to inappropriate use. Their use cancontribute to reducing the risk of acquiring the infection through a therapeutic regimen, with antiretrovirals.
PrEP is an important advance in preventionand is used before exposure to the virus, recommended for homosexuals, men who have sex with men (MSM), trans people (transsexuals and transvestites), sex workers, people who use drugs, those who are incarcerated, serodiscordant partnerships, taking into account also the repetitions of anal and / or vaginal sexual practices with penetration without the use of condoms, frequency of sexual relations with casual partners, quantity and diversity of sexual partnerships, contexts of transactional sex (for money, valuables, housing, drugs, among others), history of sexually transmitted infections and repeated search for post-exposure prophylaxis (PEP) [12–14]. This was implemented in Brazil, by the public health system on December 1, 2017 .
Although these two biomedical interventions based on drug treatment are considered essential for prevention, there are gaps in the knowledge of both HIV-negative/unknown people and among PLHIV. When revisiting studies that investigated the awareness of PrEP and PEP, it was found that the levels were below expectations. Even with the release of the use of PrEP in the United States. Similar results were observed among Nigerian university students. In Canada, MSM demonstrated incipient knowledge about PrEP including those who were HIV-negative and HIV-positive.
To achieve relevant results in HIV prevention through the use of such strategies, it is necessary to expand awareness and use education actions, focusing on people most exposed to the virus ,suchas sexual partners, whether fixed or casual, of PLHIV. In addition, expanding education actions for the general population may contribute to adherence to HIV prevention methods.
In general, knowledge about PrEP and PEP is surprisingly recent and low, even in developed countries [18–20]and in the developing world, as in the case of Brazil even among populations with strong motivations for learning to use these methods, such as couples living with HIV / AIDS. However, despite low levels of knowledge, interest in using the method was high among participants in studies from the United States.
The sexual partners of people living with HIV are populations at risk for acquiring the virus. High-risk behaviors among PLHIV may represent an important source for sexual transmission , among those who do not have an undetectable viral load. In addition, studies have shown inconsistent condom use among partners living with HIV and relating to HIV-negative people or those with unknown HIV status [4, 8].
Due to the scarcity of studies that address the theme in Brazil, this study aimed to analyze the factors associated with the knowledge of PEP and PrEP among people living with HIV / AIDS to improve policies for the implementation and distribution of strategies in a broader prevention plan among people at risk of infection.