HIV treatment cascade and associated factors among men who have sex with men in Brazil: a cross-sectional study

Men who have sex with men (MSM) have been disproportionately affected by the human immunodeficiency virus (HIV) epidemic. The HIV treatment cascade is an important clinical monitoring strategy that involves the number of MSM living with HIV in health services. This study aimed to analyze the HIV treatment cascade in the MSM population in Brazil and to identify factors associated with different cascade stages. A cross-sectional study was conducted in 12 Brazilian capitals and included 4,176 MSM recruited through respondent-driven sampling in 2016. Factors associated with each stage of the HIV treatment cascade (outcomes), i.e., HIV diagnosis, use of antiretroviral therapy, and achievement of undetectable viral load, were identified via logistic regression. Approximately 18.3% (95% CI: 15.4–21.7) of the MSM were diagnosed with HIV at the time of the survey. Among those living with HIV, only 55.5% (95% CI: 46.2–64.4) had previous knowledge of their serologic status, and 98.4% (95% CI: 96.3–99.3) of those aware of their status used antiretroviral therapy. Among those reporting using antiretroviral therapy, 80.0% (95% CI: 64.8–89.7) had a suppressed viral load, whereas 79.4% (95% CI: 64.4–89.2) had an undetectable viral load. Age > 25 years, having completed high school or higher, having a previous diagnosis of another sexually transmitted infection, and not being identified as bisexual were positively associated with all outcomes. Once enrolled in HIV treatment programs, most MSM achieve viral suppression. The challenge for HIV control is that fully half of our sample or men who tested positive did not know their HIV status. Regardless of the reason for this lack of testing, Brazil faces a continuing HIV epidemic.