Pre-exposure prophylaxis (PrEP) in primary health care: A qualitative study of users' therapeutic itineraries in the Brazilian Amazon.
6 affiliations
- 1Instituto Leônidas & Maria Deane, Fiocruz Amazônia, Manaus, Brazil.
- 2Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
- 3Universidade do Estado do Amazonas, Manaus, Brazil.
- 4Universidade Nilton Lins, Manaus, Brazil.
- 5Instituto Leônidas & Maria Deane, Fiocruz Amazônia, Manaus, Brazil. [email protected].
- 6Universidade Nilton Lins, Manaus, Brazil. [email protected].
Abstract
Background
Pre-exposure prophylaxis (PrEP) for HIV is available free of charge through the Brazilian Unified Health System, yet little is known about users' experiences in primary health care in the Brazilian Amazon. This study describes and analyzes the therapeutic itineraries (TI) of PrEP users attending a Family Health Unit (FHU) in Manaus, Amazonas.Methods
This is a qualitative, exploratory, and descriptive study based on in-depth interviews conducted between July and September 2023. Twenty HIV-negative adults (cisgender men and women, and one transgender man) using PrEP at FHU were included. Data were analyzed using MAXQDA. TI were interpreted using Arthur Kleinman's Health Care System model as an analytical framework.Results
Participants learned about PrEP through media, social networks, partners, friends, and previous experiences with post-exposure prophylaxis (PEP). Information acquired through interpersonal relationships was frequently legitimized through professional care, where testing, counselling, and access to PrEP transformed awareness into prevention practices. Continuity of care was influenced by distance, transportation costs, work schedules, stigma, and concerns about confidentiality. Primary care services were often perceived as more accessible and less stigmatizing than specialized HIV services. Interruptions and resumptions of PrEP use reflected ongoing reassessments of risk and prevention needs, while trust and supportive care relationships facilitated continuity.Conclusion
TI revealed that PrEP use is a dynamic process shaped by interactions among social networks, institutional practices, stigma, and everyday prevention strategies. Strengthening decentralized, flexible, and privacy-protective primary health care services may reduce barriers and support equitable HIV prevention in the Brazilian Amazon.
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BibTeX
@article{araujo2026preexposure,
title = {{Pre-exposure prophylaxis (PrEP) in primary health care: A qualitative study of users' therapeutic itineraries in the Brazilian Amazon.}},
author = {Patrícia Saraiva Araújo and Diego Rafael Lima Batista and Priscila Saraiva Becil and Aline Cristiane Corte Alencar and Vinícius Azevedo Machado and Stefanie Costa Pinto Lopes and Marcus Vinícius Guimarães Lacerda and Djane Clarys Baia-da-Silva},
journal = {BMC public health},
year = {2026},
month = jul,
doi = {10.1186/s12889-026-28273-5},
url = {https://europepmc.org/article/MED/42894146},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pre-exposure prophylaxis (PrEP) in primary health care: A qualitative study of users' therapeutic itineraries in the Brazilian Amazon.
AU - Patrícia Saraiva Araújo
AU - Diego Rafael Lima Batista
AU - Priscila Saraiva Becil
AU - Aline Cristiane Corte Alencar
AU - Vinícius Azevedo Machado
AU - Stefanie Costa Pinto Lopes
AU - Marcus Vinícius Guimarães Lacerda
AU - Djane Clarys Baia-da-Silva
PY - 2026
DA - 2026/07/01
JO - BMC public health
DO - 10.1186/s12889-026-28273-5
UR - https://europepmc.org/article/MED/42894146
AB - Background Pre-exposure prophylaxis (PrEP) for HIV is available free of charge through the Brazilian Unified Health System, yet little is known about users' experiences in primary health care in the Brazilian Amazon. This study describes and analyzes the therapeutic itineraries (TI) of PrEP users attending a Family Health Unit (FHU) in Manaus, Amazonas.Methods This is a qualitative, exploratory, and descriptive study based on in-depth interviews conducted between July and September 2023. Twenty HIV-negative adults (cisgender men and women, and one transgender man) using PrEP at FHU were included. Data were analyzed using MAXQDA. TI were interpreted using Arthur Kleinman's Health Care System model as an analytical framework.Results Participants learned about PrEP through media, social networks, partners, friends, and previous experiences with post-exposure prophylaxis (PEP). Information acquired through interpersonal relationships was frequently legitimized through professional care, where testing, counselling, and access to PrEP transformed awareness into prevention practices. Continuity of care was influenced by distance, transportation costs, work schedules, stigma, and concerns about confidentiality. Primary care services were often perceived as more accessible and less stigmatizing than specialized HIV services. Interruptions and resumptions of PrEP use reflected ongoing reassessments of risk and prevention needs, while trust and supportive care relationships facilitated continuity.Conclusion TI revealed that PrEP use is a dynamic process shaped by interactions among social networks, institutional practices, stigma, and everyday prevention strategies. Strengthening decentralized, flexible, and privacy-protective primary health care services may reduce barriers and support equitable HIV prevention in the Brazilian Amazon.
SN - 1471-2458
ER -