Sexual risk behaviors among adolescent men who have sex with men in two Brazilian cities: findings from an RDS-based study.

OBJECTIVE: To estimate the prevalence of sexual risk behaviors among adolescent men who have sex with men and to identify factors associated with these behaviors. METHODS: Data were collected between December 2020 and July 2022 in Fortaleza and São Paulo, Brazil, using respondent-driven sampling. Study outcomes included inconsistent condom use, multiple sexual partners, and sexualized drug use. RESULTS: The final sample was composed of 287 adolescents. Among participants, 38.0% reported inconsistent condom use, 36.1% reported multiple sexual partners, and 23.8% reported sexualized drug use. Factors associated with inconsistent condom use were not having a steady partner (adjusted prevalence ratio (APR): 0.5), having come out to everyone or almost everyone (APR: 6.3), consuming alcohol weekly (APR: 2.9), looking for family/friends/pharmacy (APR: 0.7), or looking for the public healthcare service when sick (APR: 0.7), and having sexual intercourse with partners of unknown HIV status (APR: 1.6). Factors associated with multiple sexual partners were receiving money in exchange for sex (APR: 1.6), and having sexual intercourse with partners of unknown HIV status (APR: 2.0). Factors associated with sexualized drug use included Catholic religion (APR: 0.2), having a steady partner < 20 years old (APR: 2.0), participating in non-governmental organization activities (APR: 2.5), experiences of violence (APR: 2.7), receiving money in exchange for sex (APR: 1.7), and having sexual intercourse with partners of unknown HIV status (APR: 2.1). CONCLUSION: These findings highlight the high prevalence of sexual risk behaviors among adolescent men who have sex with men, underscoring the need for targeted prevention strategies and youth-friendly services in diverse urban contexts.