BACKGROUND: Black people have a higher prevalence of HIV infection in several countries worldwide, including Brazil. Studies have also highlighted barriers to HIV testing in these populations because of structural racism. We aimed to investigate the association between HIV testing in a lifetime and race among adolescent men who have sex with men (aMSM) and transgender women (aTGW) in three Brazilian state capitals.
METHODS: PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aYMSM and aYTGW aged 15–19 in three Brazilian capitals: Salvador, São Paulo, and Belo Horizonte. The outcome variable was having been tested for HIV in a lifetime (no, yes). Race was self-reported in three categories: white, black, and mixed race (or brown; in Portuguese: “pardo”). In Brazil, the last one is historically combined with black in the analyses. We compared black and mixed race combined vs. white. We conducted descriptive, bivariate, and multivariate analyses to estimate the adjusted odds ratio (aOR) and 95% confidence interval (95%CI).
RESULTS: White adolescents underwent more HIV tests in their lifetime than black and mixed race combined (74.0% vs. 54.0%, respectively). The testing rates decreased as the skin tone darkened: 56.9% among exclusive blacks, 58.1% among exclusive mixed-race (or brown), and 63.9% among whites (p=0.003). In the multivariate analysis, black and mixed-race combined people were 33% less likely to have been tested for HIV in a lifetime than whites (aOR=0.67, 95%CI: 0.51-0.90), adjusting for age, education, employment, living with family, mother’s lack of knowledge about their sexual orientation, sex work, and unprotected anal sex.
CONCLUSIONS: The lower rate of HIV testing among black and mixed-race combined among aMSM and aTGW people indicates inequalities in health and structural barriers to accessing HIV testing and prevention services. Further, it evidences the structural racism in society and health institutions in Brazil.