“Everyone is embarrassed to say they have sex”: interdictions in young people’s access to HIV/AIDS prevention services in the district of Grajaú, São Paulo, BrazilAbstract
This article aims to problematize young people’s access to HIV/AIDS prevention services. In recent years, new HIV/AIDS prevention strategies have become available in the public health network. By contrast, epidemiological data shows that young people are disproportionately affected by STI, HIV, and syphilis epidemics in Brazil. This is a case study with a qualitative approach, conducted in a peripheral neighborhood in the city of São Paulo. The data was collected using three techniques: an electronic survey, semi-structured interviews, and focus groups, with young people, aged 17 to 24 years. The study found that there is a mismatch between the availability of prevention and access by young people due to the lack of access to information and the fact that the subject is considered taboo. It can therefore be concluded that the quality and reliability of the information, together with the moralization of the experience of sexuality, especially among young people, interfere with access to care technologies.
Key words:
HIV; Youth; Access to information; Sexuality; Prevention
Resumo
O artigo tem por objetivo problematizar o acesso dos jovens aos serviços de prevenção de HIV/Aids. Nos últimos anos, novas estratégias de prevenção ao HIV/Aids foram disponibilizadas na rede pública de saúde. Em contrapartida, dados epidemiológicos apontam que jovens são afetados desproporcionalmente pelas epidemias de IST, HIV e sífilis no Brasil. Trata-se de um estudo de caso com abordagem qualitativa, realizado em um bairro periférico da cidade de São Paulo. Utilizaram-se três técnicas de coleta de dados: inquérito eletrônico, entrevistas semiestruturadas e grupos focais, direcionadas a jovens entre 17 e 24 anos. Os resultados evidenciam um descompasso entre a oferta de prevenção e o acesso dos jovens decorrente de ruídos no acesso à informação e da compreensão da temática relacionar-se a um tema considerado tabu. Conclui-se que a qualidade e a confiabilidade das informações somadas à moralização acerca da vivência da sexualidade, sobretudo de jovens, interferem no acesso às tecnologias de cuidado.
Palavras-chave:
HIV; Juventude; Acesso à informação; Sexualidade; Prevenção
Resumen
Este artículo aborda el acceso de los jóvenes a los servicios de prevención del VIH/SIDA. En los últimos años, se han implementado nuevas estrategias de prevención del VIH/SIDA en el sistema público de salud. Por otro lado, los datos epidemiológicos indican que los jóvenes se ven desproporcionadamente afectados por las epidemias de ITS, VIH y sífilis en Brasil. Se trata de un estudio de caso cualitativo realizado en un barrio periférico de São Paulo. Se utilizaron tres técnicas de recolección de datos: encuesta electrónica, entrevistas semiestructuradas y grupos focales, dirigidos a jóvenes de entre 17 y 24 años. Los resultados revelan una discordancia entre la prestación de servicios de prevención y el acceso de los jóvenes, derivada de la falta de uniformidad en el acceso a la información y la percepción de que el tema es tabú. La conclusión es que la calidad y la fiabilidad de la información, junto con la moralización que rodea la experiencia de la sexualidad, especialmente entre los jóvenes, influyen en el acceso a las tecnologías de atención.
Palabras clave:
VIH; Juventud; Acceso a la información; Sexualidad; Prevención
Introduction
In recent years, new HIV/AIDS prevention strategies have emerged, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), as well as increased awareness of the virus’s non-transmissibility among people living with HIV who are on antiretroviral treatment (ART) and have been undetectable for more than six months1. These strategies, with significant potential for impact, have proven capable of reducing new infections, viral circulation, and mortality from the disease2. However, the deceleration in new infection rates in Brazil remains below expectations. In countries like Botswana, Cambodia, and Zimbabwe, whose policies combine scientific evidence, the addressing of inequalities, stable funding, and the strengthening of civil society, rates have shown consistent declines3.
Global trends demonstrate that new perspectives are needed to better understand the epidemic’s transition and move forward with its response. Reducing the rates of new HIV infections requires a focus on primary prevention and the removal of barriers of access to prevention services and programs, through strategies that prioritize the use of evidence, community participation, and the guarantee of rights, focusing on populations/territories and people-centered actions3.
Several challenges relate to HIV/AIDS care in primary care in Brazil, including ethical, institutional, technical, political, and moral issues4,5. These include: discontinuity of actions, particularly for vulnerable groups; low effectiveness of preventive actions; social inequalities; limited knowledge of effective communication strategies; lack of monitoring of actions; and social constructions of race and gender6,7. Therefore, understanding the perspectives of users and healthcare professionals on HIV prevention can contribute to improving care models and processes.
Particularly among young people, there is a trend toward increasing rates of new HIV infections, especially in developing countries like Brazil8. This group has seen a decline in condom use, but there is also a growing demand for health services9. Furthermore, young people are disproportionately affected by STI, HIV, and syphilis epidemics in the country8, highlighting the need to broaden our understanding of youth diversity and the context in which they live.
Recent data from the Notifiable Diseases Information System (SINAN) highlight the importance of prioritizing young people in prevention efforts. Between 2020 and 2023, the number of HIV infections increased by 24.1%. Regarding the profile of cases, 70.7% were male, 63.2% were Black (49.7% were brown and 13.5% were Black). The most affected age groups include young people, aged 15 to 24 years (23.2%), and adults, aged 25 to 34 years (34.9%), with 16,134 cases (34.7%) in the Southeast region10.
This article aims to understand how young people in the Grajaú district of São Paulo perceive and experience access to HIV/AIDS prevention information and services, and seeks to contribute to a reflection on this dynamic, in which, on the one hand, a powerful set of preventive measures is available, and on the other, barriers to young people’s access to health services are identified. Using data from a survey conducted in the Grajaú neighborhood of São Paulo, we sought to identify critical points in this relationship, based on young people’s perceptions of their access to HIV/AIDS care and prevention technologies.
HIV prevention Technologies
In 2023 - for the fifth consecutive year - the city of São Paulo saw a decrease in new HIV cases after implementing treatment offered to all people living with HIV/AIDS and expanding access to PrEP and PEP2.
In 2014, during the transition to the current HIV/AIDS epidemic, the Knowledge, Attitudes, and Practices Survey (PCAP) was conducted with 4,318 people, aged 15 to 64 years. The results showed that the external condom is widely known, but ART and PEP were less common11.
Although these technologies focus on the populations most vulnerable to HIV - gay men and men who have sex with men, trans women and transvestites, sex workers, and drug users - the young population is considered a priority by the Ministry of Health (Ministério da Saúde - MS). Also prioritized are the Black, homeless, and Indigenous populations.
In the first PrEP clinical protocol, launched in 2018 by the MS, although not exclusive, its priority indication was for certain population segments (gay men, men who have sex with men, trans and transvestite people, sex workers, and serodifferent couples). With the 2022 updates, PrEP is now indicated for anyone with an increased risk of HIV exposure, despite increased efforts to ensure awareness and access by the most vulnerable populations. Also included were the release of PrEP prescriptions for adolescents, aged 15 years and older, and the on-demand use modality12. The city of São Paulo, following national guidelines established by the MS, incorporated these guidelines into its local prevention and care protocols.
The use of PrEP among adolescents and young people has become a global necessity. The PrEP1519 study revealed that adolescents under 18 years of age have little knowledge about PrEP and PEP13,14. This highlights the importance of active recruitment strategies that use accessible language, rely on welcoming teams, and recognize the diversity of youth contexts to expand access, engagement, and adherence to HIV prevention15.
Another study showed that many young people have limited knowledge of new prevention technologies, such as PrEP and PEP; some are unaware of these strategies or do not know where and how to access them. Furthermore, available information technology has not been sufficient to combat the rise of conservatism and the lack of effective policies aimed at HIV prevention among young people16.
Barriers of access to new technologies
In the early 1980s, AIDS was referred to by conservative sectors of society as “gay cancer” or “gay plague.” In this conception, the disease was seen as a potential means of punishing and eradicating this population. Because it is sexually transmitted, contagion depended solely on the will of the individual, who engaged in behaviors perceived as dangerous, irresponsible, or perverse, consequently generating experiences of discrimination and persecution. This metaphorical language intensified stigma by reinforcing stereotypes of deviance and guilt and is socially constructed through discourses that serve exclusionary interests. This is not just about biomedical advances, but also a transformation of how society understands and relates to AIDS and those living with it17.
The successes in the HIV response in Brazil coexist with a dual tension between what they call “making live” - the expansion of testing - and medication availability - and “letting die” - the reinforcement of stigma and discrimination18. There is systematic progress in the development of prevention and treatment strategies, but the obstacle of prejudice has not yet been overcome. The “make live and let die” approach is evident in the relationship between HIV and the adolescent population, as actions are offered, but difficulties in establishing discussions about sexuality and youth continue18.
Although highly effective strategies exist (such as combination prevention), complex barriers to addressing HIV exist, such as stigma and prejudice, which impact the population’s access to prevention services and adherence to treatment. This also includes limited access to information and adequate health services, especially in more vulnerable regions18.
The results of this study demonstrate a lack of awareness of prevention technologies, among both young people and health professionals5,19. Our hypothesis is that, despite the availability of various technologies to combat the epidemic, access to HIV prevention strategies is marked by the stigmatization of the issue.
Materials and methods
This qualitative research, with a case study design, is a suitable strategy for investigating contemporary phenomena within their real-world context20. The data used come from the research “As perspectivas dos jovens e dos trabalhadores de saúde sobre o acesso às ações de prevenção ao HIV/AIDS”, conducted between 2020 and 2023 by a partnership between the São Paulo Municipal Health Department, CEPEDOC, USP School of Public Health and Getúlio Vargas Foundation (FGV), funded by National Council for Scientific and Technological Development (CNPq) and Department of Chronic Diseases and Sexually Transmitted Infections of the Secretariat of Health Surveillance of the Ministry of Health (DCCI/SVS/MS). The project sought to understand the barriers and potential for access to health services from the perspective of young people in highly vulnerable areas of the city of São Paulo.
Grajaú, in the city of São Paulo, is a peripheral district located in the extreme south of the city, with approximately 360,787 inhabitants in an area of 91 km². This region was selected after consultation with partners of the Municipal Health Department’s STI/AIDS Program and based on the following criteria: (1) vulnerability indicators; (2) large youth population; and (3) the existence of organized collectives and social movements related to youth and sexuality.
The first stage involved engaging with the region through virtual chats with local leaders and stakeholders to learn about the health and youth initiatives being carried out in Grajaú. Youth groups, health and education facilities, and prevention agents in the region were contacted.
Data were collected using three techniques: electronic surveys, semi-structured interviews, and focus groups. Chart 1 describes the instruments and methodologies used, and Chart 2 presents the sociodemographic profile of the research participants.
Qualitative data analysis was based on grounded theory21. Using Nvivo software, data were categorized into macro-codes: access barriers; HIV knowledge; perceptions of prevention; perceptions of risk behavior; perceptions of access to information; and perceptions of access to services.
The research was approved by the Research Ethics Committee of the São Paulo Municipal Health Department (SMS/SP), logged under opinion no. 4.077.563, CAAE: 30409020.4.3001.0086. Participants were identified by alphanumeric codes.
Results and discussion
The results are presented along two axes: 1) a lack of access to information among young people; and 2) the perception of the topic as taboo. Because the construction of dialogues between science and the local community is permeated by stigmas and prejudices, a disconnect can be identified between these two poles. In other words, by failing to recognize youth sexuality, institutions, such as the State, science, health services, and families, propose communication rife with bias and marked by moral discourse, resulting in deficient access to qualified information.
Access to information - “I thought a cocktail was a smoothie”
Access to information about HIV is influenced by various factors, such as education, culture, access to technology, and public health policies. The main information channels mentioned were: sex education in schools, internet use and social media, public campaigns and awareness events, and conversations with friends and family.
The survey found that young people seek information about HIV/AIDS online (39%), at school (34%), from health professionals (24%), and from family (20%). Interviews indicate that the main sources are school and family:
I learned this at school. The teacher didn’t say much, she didn’t have any good information, like, “Wow, you know, treat things more naturally”. Not just at school, because it’s a whole group. At home, some parents are very conservative, they don’t talk about it. I don’t think it’s an issue that only the system can solve. It’s about people, it’s at home, at school, in the environment where you live (Interview - participant B, female).
Han22 asserts that we live in a society of information addicts, with a growing tendency to seek information. However, the author questions if in fact this search has effectively generated knowledge construction. The young people’s statements indicate that information channels on HIV prevention are insufficient and do not generate meaningful meaning or knowledge in a relevant way. Thus, the question arises as to what content is presented and how it is addressed in the circles inhabited by young people.
Leal and Coêlho23 question whether there is truly a lack of information on the topic or whether the issue lies in the approach, given that hegemonic sexual education proposals reproduce a moralistic discourse and do not provide a space for frank and open dialogue. According to the authors, for such proposals to be effective, it is necessary to incorporate welcoming interventions, recognizing the role of individuals, and integrating social values and representations of health and disease that are sensitive to the specific behaviors of individuals in given contexts.
I think that not having so much information about what can happen to a person, you know, thinking that it’s just an STD and everything is fine, or sometimes they don’t even know how much it can worsen their life (Interview - participant F, woman).
The diversity of prevention technologies is relatively unknown among the young people surveyed in this study. The scarce and superficial communication about sexuality in schools and families has a moralizing bias that defines what is necessary to know and how this learning will occur. The effort to organize the way we talk, think, and experience sex stands out, seeking to control how people perceive themselves and others in relation to their sexual experiences24. In this dynamic, the pursuit of knowledge can be labeled as inappropriate, leading to the circulation of incomplete or outdated information:
I’ll be honest, the only HIV prevention I know about is condoms. I know there’s a cocktail, but I don’t know how to talk about it, I don’t know how it works. Until recently, I thought it was just a cocktail, a smoothie (Interview - Participant A, male).
I didn’t have much access [to information at home, with my family]. It was exactly like I’m telling you, it was taboo, it wasn’t discussed. It wasn’t discussed because in my head it’s like: we don’t even need to talk about it, it’s not going to happen (Interview - Participant A, male).
While the internet is a valuable source of information, it can also be an environment where prejudice and fake news proliferate. As for families, in many situations, sexuality is an avoided topic, which can lead to a lack of open communication about HIV/AIDS. And, while schools are strategic places for sex education, they often face challenges in addressing the topic due to political and cultural pressures:
For example: the issue of sexual education in schools should be a topic addressed in schools, but the family itself, depending on the situation, may see it as a certain ideology, instead of looking at it as a form of information (Interview - participant A, male).
One possible space for accessing appropriate information could be a SUS facility, but data indicate that young people do not recognize this possibility. Amid the moralizing discourse on sexuality present in many family and school settings, health services seem to be overlooked as appropriate resources for sexual and reproductive health education and information. Some interviewees reported that their most consistent knowledge about HIV was acquired late: after experiencing a situation perceived as potentially exposing them to the virus. Since then, they have sought specialized care. It is important to note that young people’s general perception is that the information they have is insufficient for developing prevention practices that ensure their safety in the face of possible HIV exposure.
One example cited was the lack of educational campaigns in mass media. This type of information dissemination could mitigate the knowledge deficit, as it has a broad reach and is generally transmitted on open platforms. Some young people perceive that transmission rates are stabilizing or decreasing, which would justify the issue of HIV/AIDS losing media coverage and centrality in public health policymaking. For these young people, widespread information about services would help overcome some of the communication constraints they experience at home and at school:
Misinformation is what really hinders people’s access. I think there should be more campaigns, not just during Carnival and New Year’s, but it should also be a constant part of our daily lives. You can walk by and see a banner, you can walk by and see a poster, you can sit in front of the TV and have people talking. I think it should be more common in our daily lives and perhaps explain more about how it works (Interview - participant M, female).
A while ago, I was talking in a circle of friends with five people, and no one knew that the SUS offered this type of testing service for people who had had unprotected sex. It’s important to inform people about this service and how it’s provided, as we often don’t know what’s being done and what needs to be done (Interview - participant G, male).
On the other hand, it was observed that when young people seek health services to access qualified and updated information, they may find outdated professional practices or practices based on moralizing perspectives that seek to control the experience of youth sexuality5.
The things you see in emergency rooms and clinics are that jar full of condoms and something like, “AIDS kills”, some shocking phrase. It’s always like that. There’s no point in instilling fear; you need to provide information (Interview - participant R, female).
Ten years after PCAP11 began fieldwork, we identified significantly low knowledge about combined HIV prevention among Grajaú’s youth. Although many know where to access condoms and recognize testing as a form of prevention, PrEP and PEP are less popular. Only 30% of young people (survey) were already familiar with these technologies:
Some medications that some of my friends mention they’ve already used, that PrEP and PEP, I don’t know, I don’t remember which one exactly, I know there’s one near my house. I know there’s a UBS, but it’s only for STDs, and so I know they do that there, I think they do tests, offer medication, and have those antiretrovirals too. That’s what I remember now (Interview - participant B, female).
In short, it is clear that the availability of data alone does not guarantee the production of significant knowledge about HIV prevention, since the accumulation of information does not always result in critical understanding22. The limitations of hegemonic approaches to sexual education - marked by moralizing discourses and practices of body surveillance - reinforce the diagnosis of Leal and Coêlho23, who point to the urgency of welcoming and comprehensive interventions, capable of recognizing the protagonism of youth and engaging with their unique experiences.
Sex as a taboo - “Everyone is ashamed to say they have sex”
One of the main obstacles highlighted by the young people interviewed in this study was the insufficient guidance offered in their social circles. The taboo around sex was related to the restriction of dialogue about sexual experiences, both at home and at school. The taboo materializes in moral discourses that make people feel embarrassed about seeking information and accessing the health network. The tension surrounding the active sexual lives of young people, especially girls and women, stands out. Most of the young people interviewed know little about HIV/AIDS:
I know very little, so much so that it’s taboo to talk about AIDS (Interview - participant A, male).
In these cases, the family is not seen as a potential interlocutor to address the issue:
Actually, knowing how to prevent it is more common online because no one [at home] will know how to explain it (Focus group - participant L, male).
I’m not close enough with my parents to go up and talk about it; I think it’s easier to talk about these things with a stranger than with my parents (Interview - participant D, female).
There is even pessimism regarding the possibilities of dialogue, which would be stifled due to moral surveillance:
This isn’t discussed at home, this isn’t discussed at school. And sometimes, as was the case at my school, if there are more practical classes like how to use condoms, how to properly take precautions, families often also cut them off, stifle these ideas (Interview - participant T, female).
The effects of a lack of informed dialogue about sexuality and STI prevention can, in the view of young people, manifest themselves in insecurity regarding decisions to be made, in the difficulty in perceiving themselves as vulnerable, and in the formation of their own subjectivity. According to Brandão25, the inhibition of youth sexuality is mobilized by a pedagogy whose grammar is based on the notion of risk, imposing a prohibition on the topic. Thus, the taboo would serve to ward off “sexual danger” and regulate “out-of-control sexualities”26:
Whenever a father says, “No, I’m not going to talk about that,” or a mother does the same, the person will feel a barrier, and it’s already a taboo subject for them. Because if they don’t feel free to talk about it even at home, who will they talk to? And often, their friends don’t know how to talk about it either. They just have a closed-minded view, and we’ll talk in a closed-minded way too, and you’re shaping the person’s mind (Interview - participant S, female).
For young women who found an opening in their families to talk about sex, this generally occurred with the onset of their first period. As other studies demonstrate27,28, it is observed that girls are held individually responsible for the risks involved in experimenting with sexuality.
The interviews indicate that sex education is a maternal responsibility, as none of the interviews mentioned the father as a source of information or as a mentor on issues related to sexuality or STI prevention:
My mother always had very open conversations with me about this; it helped me a lot. My father was always a bit shy, so my mother was the one who spoke directly to me. My mother always gave me a lot of advice; we talked for hours and hours, especially when I lost my virginity (Interview - participant B, female).
I was terrified [of telling my mother about my first sexual encounter], but it was okay, and she started guiding me, telling me to be careful. She always called me to talk if I needed anything, if something unusual was happening, if I wanted to ask her anything. I always received a lot of guidance at home, about birth control, condom use, both to avoid pregnancy and for my health (Interview - participant E, female).
Still regarding girls, the conversation about condoms may be accompanied by the recommendation to use contraceptives:
When my mother found out I was already having sex, she immediately took me to the doctor and started buying medicine. And she said: take the medicine, but not just the medicine, but also a condom, because medicine doesn’t prevent the disease (Focus group - participant S, female).
In public health - as a field of knowledge and practice - the development of contraceptive techniques was not accompanied by a debate on sex, eroticism, and pleasure25. Cabral27 argues that “it is as if the effective management of contraception - often reduced to the issue of information and access to contraceptive methods - allowed for a complete disconnect between sexuality and reproduction”27 (p.16).
Another report also notes gender inequality acting as an obstacle to the healthy experience of sexuality and access to contraceptive and STI prevention technologies:
Sex is like a taboo. Everyone’s embarrassed to say they have sex, that they do it, and so on. For girls, especially, it’s something... wow! If you’ve already lost your virginity, at least nowadays, right? Wow! My God! So, people go in more afraid of being judged. For example, they’re even afraid to buy the morning-after pill, to be embarrassed to go to the pharmacy. I think that’s really detrimental (Interview - participant B, female).
Taboo takes center stage in this discussion, as it acts as an obstacle to treating HIV/AIDS comprehensively and without stigmatizing those affected by the virus. At this point, the awareness of young people regarding prevention should be highlighted. On the one hand, some of the interviewees identified the existence of available information and expressed a lack of interest in learning more (whether at home or at school). On the other hand, a portion argued that this lack of interest may be associated with a psychological barrier underlying the taboo on sex, related to social pressure to conform to standards of behavior that are far removed from the concrete experiences of youth.
Therefore, it is as if the demand for HIV/AIDS prevention services or sex education presumes inappropriate behavior, which is especially problematic for young women, given gender inequalities25. Moral discourses transform young people’s usual behaviors into degenerate or atypical behaviors, which adds to the lack of recognition of youth sexuality and the reification of social hierarchies, such as race, class, gender, region, among others28.
This archaic thing we have, that women have to worry about this, they have to go after it, they have more control. When you have a cis[gender] man, for example, for him it’s like: get on with it, take care of yourself! And we rarely have people with this lifestyle who take care of themselves. There are many men who have never even had a test. [...] Everyone knows that female condoms are a huge taboo: they don’t use them, they don’t even know how they work. I think if I could find a way for women to have control over this, maybe... This is speaking of a cis[gender] relationship (Interview - participant F, woman).
Several interviewees emphasized the need to talk openly about sexual practices among young people and, consequently, the related health risks, highlighting the importance of reversing the tendency to instill fear in order to prioritize education for conscious and informed choices.
The taboo surrounding sexuality hinders young people’s access to information about HIV/AIDS, due to family and school silence and the moralization of sexual practices, especially among girls. This reinforces gender inequalities and limits youth autonomy. The lack of safe spaces for dialogue makes prevention a topic surrounded by fear and judgment. Therefore, young people demand open, welcoming sex education that aligns with their experiences.
Aligning access to information with the sex taboo
The availability of technologies, such as condoms (external and internal), PrEP, PEP, and testing in public health services, is not the only component regulating access to STI/HIV prevention services. The data produced by the survey indicate that the quality and reliability of information, combined with the moralization surrounding sexual experiences, especially among young people in peripheral areas, significantly impact access to care technologies.
The young people interviewed do not feel informed by campaigns or other communication strategies, which may indicate a disconnect between the content presented in these pieces and the concrete reality of their experiences in the different settings in which they are inserted. Thus, the coexistence of multiple approaches to sexuality originating from public health is identified. On the one hand, the State offers care inputs and technologies for STI prevention from a comprehensive perspective, in which sex is part of people’s lives; on the other, there is a strongly regulatory bias that seeks to control sexual experiences and even discourage them25.
Youth sexuality has been systematically addressed in conjunction with notions of danger and threat to the prevailing moral and social order24, since it is associated with sexual permissiveness, the perpetuation of poverty, family breakdown, and the failure of life projects. The virtual risks to successful life trajectories have justified a series of interventions targeting this population from the public policy perspective25,27. These elements gain even greater prominence in the peripheral context, where social inequalities are intertwined with the stigma historically associated with the disease6,18. Thus, the peripheral territory operates not only as a geographic marker, but also as an active element in the production of vulnerabilities that affect access to information and services.
The regulation of youth sexuality consists of a sociohistorical process that approaches sex through modulations aimed at controlling how sexuality will be experienced. In addition to imposing prohibitions, notions of good/appropriate and bad/inappropriate sex are developed, depending on the presence or absence of the reproductive nature of (hetero)sexual practices, reinforcing the connection between sexuality and reproduction26. The prevalence of this system plays a kay role in the constitution of discourses and behaviors about sex.
Controlling access to information is an integral part of the taboo surrounding sex. This perspective is evident in the persistence of traditional morality that imposes “shame,” delineates gender boundaries (power relations), and defines sexuality as appropriate and legitimate. Indeed, the body, its sensations, pleasures, anatomy, and dispositions, are consolidated as a field of ongoing dispute among institutions, such as the church, school, family, science, and medicine24.
The silence and prohibition perpetuated by the taboo around sex reinforce stereotypes about HIV/AIDS in the social imagination, distancing young people from acquiring knowledge and preventive practices. The young people interviewed demanded more specific knowledge about HIV/AIDS, for instance: what it is, what the difference is between HIV and AIDS, how transmission occurs, how it affects health, how to protect oneself from it, and how to treat it.
Final considerations
The survey data point to a discrepancy between the availability of HIV/AIDS care and prevention technologies available through SUS and young people’s knowledge of the existence and availability of these resources within the public health system. The lack of reliability in the quality of information young people access through the family, the internet, and even school emerges as a core element in this scenario. The impact of relationships of vulnerability were also identified, since the field in which the research took place is permeated by social hierarchies of race/ethnicity, gender, class, region, and the historical stigma associated with HIV/AIDS.
It can therefore be concluded that HIV/AIDS prevention discourses are manipulated as moral tools to generate fear and promote a policy of abstinence or postponement of young people’s sexual lives based on silencing and prohibition. Thus, the focus on preventing pregnancy and other diseases and injuries excludes such issues as pleasure, the body, and rights, placing risk as a form of punishment for exercising sexuality. The so-called prevention of “early sexual risk”29 mobilizes mechanisms to control behavior, especially sexuality, and reinforces stereotypical gender patterns, as it reiterates the idea that reproduction is an issue that primarily concerns women30.
We believe that the results of this research can contribute to the development of strategies to promote young people’s sexual autonomy and access to information and health services. Considering young people as political subjects with rights implies promoting sex education based on strengthening their autonomy, in line with the human rights perspective. To further this analysis, future studies should encompass the different cultural and social contexts in which young people find themselves.
References
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Funding
The research project was funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and the Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis da Secretaria de Vigilância em Saúde do Ministério da Saúde (DCCI/SVS/MS).
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Data availability statement
The data sources adopted in the research are indicated in the article’s body.
The data sources adopted in the research are indicated in the article’s body.
