Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study.

Background: Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects.

Objective: We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study.

Leveraging Social Networks to Integrate Depression Treatment into Primary Health and Tuberculosis Care in Brazil.

Background: Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems.

Objective: To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil.

The impact of psychiatric symptoms on condom self-efficacy among people with serious mental illness.

Objective: To determine how psychiatric symptoms affect the self-efficacy of people with serious mental illness to protect themselves and their partners from HIV and other sexually transmitted infections (STIs) by using condoms.

Method: As part of a National Institute of Mental Health-Funded study, people with serious mental illness ( = 467) were recruited in public psychiatric outpatient clinics in Rio de Janeiro, Brazil for an HIV prevention intervention. We examined the effects of psychiatric symptom severity on condom self-efficacy at baseline across 4 symptom clusters: affect, positive, negative, and activation.

Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system.

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science.

[Sexuality and STD/AIDS prevention in mental health care: the views and practices of mental health professionals in the city of Rio de Janeiro, Brazil].

Despite major strides in the Psychiatric Reform and high HIV rates among users of mental health services, there is a lack of prevention policies for this population. The gap is further aggravated by mental health professionals' difficulty in approaching the sexuality of mental health care users. The article analyzes the perceptions and practices of mental health professionals concerning these issues in three service models in the Network of Psychosocial Care (RAPS) in the city of Rio de Janeiro, Brazil.

Ending AIDS as a Public Health Threat: Treatment-as-Usual Risk Reduction Services for Persons With Mental Illness in Brazil.

Objective: Persons with mental illness have higher HIV infection rates than the general population. Little is known about whether care systems for this population are effectively participating in global efforts to end AIDS as a public health threat. This study examined treatment-as-usual HIV risk reduction services within public mental health settings.

Mental illness sexual stigma: Implications for health and recovery.

Objective: The majority of people in psychiatric care worldwide are sexually active, and studies have revealed sharply elevated rates of HIV infection in that group compared with the general population. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care.

A brief photo-biography of crack users from Rio de Janeiro's metropolitan area: their settings and tools.

This brief report presents and comments pictures taken during fieldwork carried out in drug scenes, located in the metropolitan area of Rio de Janeiro, Brazil, as part of the National Crack Cocaine Survey, 2011-2013. The pictures depict contrasting settings where the ethnographic and epidemiologic components took place, as well as tools and devices used for smoking crack cocaine. As can be easily visualized, settings and tools tend to be quite variable, frequently beyond/in opposition to stereotypes.

Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil.

We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains ("Personal Experiences," "Perceived Attractiveness," and "Relationship Discrimination"), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past 3 months in 98 outpatients with SMI. Those who reported greater "Relationship Discrimination" stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV.

Sexuality, vulnerability to HIV, and mental health: an ethnographic study of psychiatric institutions.

This paper presents data from the ethnographic based formative phase of the Interdisciplinary Project on Sexuality, Mental Health, and AIDS (PRISSMA), sponsored by the National Institute of Mental Health (NIMH) and carried out in two psychiatric institutions in the city of Rio de Janeiro, Brazil. Results from ethnographic observations, focus groups, and key informant interviews with different groups of mental health care providers and day hospital and outpatient mental health clients regarding conceptions of sexuality and HIV vulnerability are described. The results suggest a diversity of notions about sexuality by both groups and point out the high HIV sexual risk in this psychiatric population.

A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil.

As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit to a new context and culture.