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      Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM) Translated title: Síntesis temática de estudios cualitativos de prevención del VIH en hombres que tienen sexo con hombres (HSH)

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          Abstract

          Background:

          Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions.

          Objective:

          To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM.

          Methods:

          We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases.

          Results:

          Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks.

          Conclusion:

          we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.

          Resumen

          Antecedentes:

          Los estudios cualitativos sobre estrategias y métodos de prevención del VIH entre hombres que tienen sexo con hombres ayudan a identificar lagunas de conocimiento y mejorar las acciones preventivas.

          Objetivo:

          Realizar una síntesis temática de las producciones científicas que utilizan la metodología cualitativa en las estrategias y métodos del área de prevención del VIH entre hombres homosexuales.

          Métodos:

          se realizó´ una revisión de la literatura siguiendo las pautas del protocolo ENTREQ. Se analizaron 48 estudios empíricos publicados en portugués, inglés y español entre 2001 y 2018 incluidos en las bases de datos Medline, Embase, Scielo, Scopus, Bireme y Web of Science.

          Resultados:

          La producción de artículos fue mayor en los últimos seis años, concentrados en los países del norte. Se abordaron siete métodos de prevención, con énfasis en profilaxis previa a la exposición, pruebas diagnósticas, condones y estrategias comportamentales. Los principales temas discutidos fueron el estigma y las redes de apoyo y atención.

          Conclusión: La creciente producción de prevención en el segmento hombres que tienen relaciones sexuales con hombres resulta de la aparición de múltiples métodos y estrategias preventivas y sus acciones combinadas más allá del protagonismo de los condones.

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          Most cited references82

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          As redes de atenção à saúde

          As transições demográfica e epidemiológica significam um incremento relativo das condições crônicas. Tem sido assim, no Brasil, que apresenta uma situação de saúde de tripla carga de doenças, manifestada na convivência de doenças infecciosas, parasitárias e problemas de saúde reprodutiva, causas externas e doenças crônicas. Há uma crise dos sistemas de saúde contemporâneos que se explica pela incoerência entre uma situação de saúde com predomínio relativo forte de condições crônicas e uma resposta social através de sistemas fragmentados e voltados, principalmente, para as condições agudas e as agudizações das condições crônicas. Essa crise se manifesta em nosso país, tanto no setor público quanto no setor privado. A solução para essa crise está em recompor a coerência entre a situação de tripla carga de doenças com uma resposta social estruturada em sistemas integrados de saúde: as redes de atenção à saúde. Conclui-se que há evidências na literatura internacional de que as redes de atenção à saúde podem melhorar a qualidade dos serviços, os resultados sanitários e a satisfação dos usuários e reduzir os custos dos sistemas de atenção à saúde.
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            HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action.

            Internationally, there has been a recent resurgence of interest in HIV and AIDS-related stigma and discrimination, triggered at least in part by growing recognition that negative social responses to the epidemic remain pervasive even in seriously affected communities. Yet, rarely are existing notions of stigma and discrimination interrogated for their conceptual adequacy and their usefulness in leading to the design of effective programmes and interventions. Taking as its starting point, the classic formulation of stigma as a 'significantly discrediting' attribute, but moving beyond this to conceptualize stigma and stigmatization as intimately linked to the reproduction of social difference, this paper offers a new framework by which to understand HIV and AIDS-related stigma and its effects. It so doing, it highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. It highlights the limitations of individualistic modes of stigma alleviation and calls instead for new programmatic approaches in which the resistance of stigmatized individuals and communities is utilized as a resource for social change.
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              Stigma, HIV and health: a qualitative synthesis

              Background HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV. Methods A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. Results The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy. Conclusion This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2197-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Colomb Med (Cali)
                Colombia Médica : CM
                Universidad del Valle
                0120-8322
                1657-9534
                30 September 2019
                Jul-Sep 2019
                : 50
                : 3
                : 201-214
                Affiliations
                [1 ] Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, Programa de Salud Colectiva, São Paulo, Brasil
                [2 ] Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, São Paulo, Brasil
                Author notes
                Augusto Mathias. Título: Psicólogo, Magister en Ciencias (Medicina Preventiva) Programa de Salud Colectiva, Facultad de Medicina, Universidade de São Paulo. Address: Av. Dr. Arnaldo, 455, Sala 2177. Cerqueira César, São Paulo, São Paulo. CEP 01246-903. Phone: +55 11998679772. E-mail: amathias@ 123456usp.br

                Conflict of interest: nothing

                Author information
                http://orcid.org/0000-0002-5896-9223
                http://orcid.org/0000-0002-6169-9455
                http://orcid.org/0000-0001-5157-0597
                http://orcid.org/0000-0001-5233-4190
                Article
                10.25100/cm.v50i3.4078
                7141148
                09d4623e-c2cf-420d-be91-d9e6b933aacd
                Copyright © 2019 Universidad del Valle

                This article is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
                : 14 June 2019
                : 16 July 2019
                : 30 August 2019
                Page count
                Figures: 2, Tables: 14, Equations: 0, References: 92, Pages: 14
                Categories
                Review Article

                hiv,prevention,review,men’s health,sexual and gender minorities.,vih,prevención,revisión. minorías sexuales,género.

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