Sexualized Drug Use Among Sexually and Gender Diverse Adolescents in Brazil

Sexualized drug use (SDU) is a known phenomenon with significant implications for HIV vulnerability. Chemsex, a specific subset of SDU, involves the use of substances such as GHB/GBL, mephedrone, or methamphetamine to facilitate sexual activity. This study investigated factors associated with SDU among sexual and gender diverse adolescents (SGDa) in Brazil. This study used data from the PrEP15-19 project, a cohort investigating the implementation of daily oral PrEP among SGDa in Brazil. A structured sociobehavioral questionnaire was administered at baseline between February 2019 and February 2023. SDU was defined as the use of alcohol or drugs before or during sexual intercourse. Bivariate and multiple logistic regression models were used to identify factors associated with SDU. Among 1,264 adolescents, the prevalence of SDU was 30.1%. The most frequently used substances in the three months prior to the survey were alcohol (87.7%), marijuana (44.8%), and cocaine (8.5%). The prevalence of chemsex was low (2.4%). Adjusted factors significantly associated with increased SDU included: being a transgender woman (aOR: 1.80; 95% CI: 1.04-3.11); engaging in transactional sex in the last 3 months (aOR: 2.16; 95% CI: 1.45-3.23); engaging in group sex in the last 3 months (aOR: 1.54; 95% CI: 1.07-2.22); and having more than three sexual partners in the last 3 months (aOR: 1.67; 95% CI: 1.20-2.33). SDU has a high prevalence among Brazilian SGDa and represents a critical factor in understanding the high rates of HIV infection in this population.