Community violence in the HIV risk environment: a qualitative study among youth in Brazil

In Brazil, HIV infection rates are rising among youth aged 15-24 years. HIV prevention efforts often overlook social determinants of health as barriers to engaging in health behaviors. This study investigates how community violence influences HIV risk among youth. We conducted qualitative analysis of semi structured interviews with youth (N = 53) from two urban peripheries in São Paulo and Porto Alegre, using the HIV risk environment framework to guide analysis. Our findings indicate that police violence and gang activity are pervasive in youth-frequented spaces, disrupting daily life and creating an environment of fear and intimidation, limiting freedom of movement. Violence accelerates social insecurities, particularly among young males and Black youth, who are disproportionately targeted. Substance use links community violence to HIV risk. Community violence hinders educational attainment and employment opportunities, perpetuating cycles of poverty and instability. Aggravated burglaries and economic strain force individuals into high-risk activities, further entrenching them in violence and increasing vulnerability to HIV. Policing practices, characterized by aggressive interventions, exacerbate the HIV risk environment by fostering distrust and driving community members towards gangs for protection. While free HIV testing and treatment are available, barriers such as community violence hinder access to care. This study affirms the need for interventions that address the root causes of violence to improve the HIV risk environment and health disparities among at-risk Brazilian youth.