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Factors associated with depressive symptoms among adolescent's men who have sex with men and transgender women enrolled in a PrEP cohort in Brazil

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BACKGROUND: Mental health issues such as depressive symptoms (DS) are more prevalent among men who have sex with men and transgender women (MSM/TGW) than in the general population, and it can affect the adoption of HIV prevention methods. In recent years, the HIV epidemic has grown among MSM/TGW adolescents, but data on DS in this population is scarce. We aimed to investigate factors associated with DS among adolescents'' key population (AKP) of MSM/TGW in Brazil.
METHODS: Baseline data from the first demonstration PrEP cohort study among AKP 15-19 years old ongoing in three large Brazilian cities (PrEP1519). Participants were enrolled in the cohort between March/2019-December 2020. DS was defined according to the Center for Epidemiological Studies-Depression Scale (CES-D) score (range of possible scores: 0-60). A total score of 16 or greater on CES-D indicates a possible clinically significant DS condition. A socio-behavioral questionnaire was applied and multivariate analyses were performed using logistic regression with adjusted odds ratio (aOR) and 95% confidence intervals (95%CI) estimation.
RESULTS: The prevalence of DS was 61.1% (95%CI: 57.2-64.9%) among the AKP. Factors associated with DS were lower educational level (aOR=2.12, 95%CI:1.05-4.40), worse self-perception of health (aOR=1.74, 95%CI=1.14-2.65), intimate partner psychological violence (aOR=1.98, 95%CI=1.12-3.51), the experience of sexual violence (aOR=3.77, 95%CI=2.34-6.09) and fear to walk in public spaces due to sexual orientation or gender identity (aOR=1.74, 95%CI=1.18-2.57).
CONCLUSIONS: Our findings report a high and worrisome prevalence of DS among AKP in PrEP cohort study, which points to the need for greater care for this population using PrEP. Furthermore, DS were associated with vulnerability factors such as low education, violence and discrimination experience, and these are key elements to inform better policies, and interventions to improve the health of AKP, specifically mental health disorders.