Racial disparities in HIV incidence and PrEP non-adherence among gay, bisexual and other Men who have Sex with Men (MSM) and transgender women using oral PrEP in Brazil: Results from the ImPrEP study

Q: What was the main purpose of the ImPrEP analysis in this article?

To assess HIV incidence and identify factors associated with PrEP non-adherence among MSM and transgender women in Brazil, with a focus on potential racial disparities.

Q: How did the study define PrEP non-adherence?

PrEP non-adherence was defined using medication possession rate, with non-adherence corresponding to medication possession rate below 0.6.

Q: Which racial groups showed higher HIV incidence and PrEP non-adherence?

Black and Pardo participants had higher PrEP non-adherence than White participants, and HIV incidence was higher among Black participants compared with Pardo and White participants.

Sep 28, 2026

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Access to health services influences PrEP uptake, adherence, and persistence, particularly for populations affected by structural inequities. This study evaluates HIV incidence and factors linked to PrEP non-adherence among men who have sex with men and transgender women in Brazil, emphasizing potential racial disparities. Data come from the prospective ImPrEP implementation study using oral PrEP in 14 clinics across 11 Brazilian cities, with incidence modeled by race and logistic regression identifying adherence correlates.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Background on HIV burden and prevention

PrEP and vulnerability among minority groups

Racial disparities in Brazil

Material and methods

ImPrEP study design and participants

PrEP regimen and adherence definition

Statistical analysis approach

Results

Participant racial/ethnic distribution

Differences in PrEP non-adherence by race

HIV incidence by racial/ethnic group

Multivariable correlates of non-adherence

Conclusions

Braz J Infect Dis. 30 (2026) 104614 Contents lists available at ScienceDirect Brazilian Journal of Infectious Diseases journal [homepage:](homepage: www.elsevier.com/locate/bjid)[ www.elsevier.com/locate/bjid](homepage: www.elsevier.com/locate/bjid) | Original Article
Racial disparities in HIV incidence and PrEP non-adherence among gay, bisexual and other Men who have Sex with Men (MSM) and transgender women using oral PrEP in Brazil: Results from the ImPrEP study | | | | --- | --- | --- | | Lucilene Araujo Freitas a,1 , Carolina Coutinho a,1 , Debora Castanheira a ,
Ronaldo Ismerio a , Pedro Leite a, Iuri C. Leite b, Marcelo Cunha b , Josias Freitas a,
Toni Araujo a, Laylla Monteiro a, Brenda Hoagland a , Mayara S.T. Silva a , Marcos Benedetti a, Cristina Pimenta a, Beatriz Grinsztejn a, Valdilea G. Veloso a,2, Thiago S. Torres a,2,3,*
a Instituto Nacional de Infectologia Evandro Chagas, Fundaç˜ao Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil b Escola Nacional de Saúde Pública S´ergio Arouca, Fundaç˜ao Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, RJ, Brazil | | | | A R T I C L E I N F O
Editor: Dr. Luciano Goldani
Keywords:
Race
Racism
Discrimination Homophobia
Sexual and gender minorities LBTQIAPN+
Latin America | A B S T R A C T
Introduction: Access to health services may affect PrEP uptake, adherence, and persistance, especially among persons affected by structural inequities. We assessed the HIV incidence and factors associated with PrEP nonadherence among men who have sex with men (MSM) and transgender women in Brazil, focusing on potential racial disparities.
Material and methods: ImPrEP was a prospective, single-arm, open-label, PrEP implementation study that enrolled 9509 MSM and transgender women in Brazil, Mexico and Peru (February 2018 ‒ June 2021). Participants received oral PrEP with tenofovir disoproxil fumarate and emtricitabine at the enrollment visit and quarterly thereafter. This analysis was restricted to data from 14 HIV/STI clinics in 11 cities from Brazil. We calculated the HIV incidence per 100 person-years using the Poisson model according to race. We used adjusted logistic regression models to identify factors associated with PrEP non-adherence (medication possession rate < 0.6) for White and Black/Pardo participants separately. Trial registration: UTN U1111-1217-6021
Results: Of 3928 participants, 1868 (47.6%) self-identified as White, 1410 (35.9%) Pardo, 595 (15.1%) Black, 42 (1.1%) Asian, and 12 (0.3%) Indigenous. PrEP non-adherence was higher among Black (26.2%) and Pardo (24.2%) compared to White (18.7%) participants (p < 0.0001). Among participants with PrEP non-adherence, HIV incidence was higher among Black (2.16 [95% CI: 0.54‒8.63]) than Pardo (1.49 [95% CI: 0.48‒4.62]) and White (1.00 [95% CI 0.25‒4.01]). In multivariable models, participants aged 18‒30 years, self-identifying as transgender women, and reporting lower number of sex partners had increased odds of PrEP non-adherence among White and Black/Pardo participants. Lower education and transactional sex were associated with increased odds of PrEP non-adherence among Black/Pardo, but not among White participants.
Conclusions: Higher HIV incidence and PrEP non-adherence among racially and ethnically marginalized groups, such as Black and Pardo Brazilians, highlights the impact of structural racism on health outcomes. The implementation of public policies to reduce racial and social inequities in HIV prevention must be prioritized in Brazil. | | Introduction Despite major advances in prevention and treatment strategies in recent decades, HIV remains a major global public health problem. In 2024, there were 1.3 million new HIV acquisitions worldwide.1 In contrast with other regions, the HIV incidence continues to increase in * Corresponding author. [E-mail address:](E-mail address: thiago.torres@ini.fiocruz.br)[ thiago.torres@ini.fiocruz.br](E-mail address: thiago.

FAQs

What was the main purpose of the ImPrEP analysis in this article?

To assess HIV incidence and identify factors associated with PrEP non-adherence among MSM and transgender women in Brazil, with a focus on potential racial disparities.

How did the study define PrEP non-adherence?

PrEP non-adherence was defined using medication possession rate, with non-adherence corresponding to medication possession rate below 0.6.

Which racial groups showed higher HIV incidence and PrEP non-adherence?

Black and Pardo participants had higher PrEP non-adherence than White participants, and HIV incidence was higher among Black participants compared with Pardo and White participants.

Sep 28, 2026

Uploaded by kopisore