Fundação Oswaldo Cruz, Instituto de Comunicação E Informação Científica E Tecnológica Em Saúde, Rio de Janeiro, RJ, Brasil.
Ministério da Saúde, Secretaria de Vigilância Em Saúde, Brasília, DF, Brasil.
BMC Public Health. 2023 Aug 2;23(1):1476. doi: 10.1186/s12889-023-16420-1.
Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs).
Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied.
Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner.
The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.
涉及监测高危性行为的人口调查已被公认为控制 HIV 流行和其他性传播感染（STIs）的重要公共卫生工具。
利用来自知识、态度和实践调查（PCAP-2013）和国家健康调查（PNS-2019）的数据，根据 18-64 岁个体的社会人口特征比较性行为指标，包括男男性行为者（MSM）和女女性行为者（WSW）的比例（%）估计数。具体来说，比较了 PNS-2019 中同性恋、双性恋、异性恋男性和女性的流行率估计值与 PCAP-2013 中的流行率估计值。为了比较 PCAP 和 PNS 的比例分布，应用了皮尔逊卡方检验，调整了 Rao-Scott 校正。
PCAP-2013 直接询问获得的 MSM 和 WSW 的比例（%）估计值显示，同性恋的流行率估计值高于 PNS-2019 自我报告的性取向。根据 PCAP-2013（3.7%；95%CI 3.1-4.4%）和 PNS-2019（2.2%；95%CI 1.9-2.5%），MSM 比例之间存在显著差异，以及 WSW 比例（4.6%；95%CI 4.0-5.4%）和（2.1%；95%CI 1.8-2.4%）。这两个调查结果均显示，MSM 和 WSW 的流行率估计值随教育程度的提高而增加，随年龄的增长而降低，并且在不与伴侣生活、居住在城市和州府的人群中更大。关于最近一次性行为中使用安全套，PCAP-2013 和 PNS-2019 的全国估计值之间没有差异，但 MSM、18-24 岁和 25-34 岁人群以及不与伴侣生活的人群的安全性行为有所改善。
自我报告的性取向低估了 MSM 和 WSW 的流行率，这表明性少数群体在披露其性取向方面面临许多困难，这加强了为改变人口态度和促进性取向披露而制定公共卫生干预措施的重要性。此外，相隔 6 年进行的两次调查（PCAP-2013 和 PNS-2019）中安全套使用率均较低，这突出了需要制定公共政策来扩大预防策略，以预防 HIV 感染和其他性传播感染。
