Desigualdades na saúde sexual entre adolescentes e adultos brasileiros: PeNSE e PNS 2019

Abstract

Background: Brazil faces inequalities across various dimensions, including economic, sex, ethnic, and place of residence. The economic context may distinctly shape behavioral patterns and sexual health service utilization among adolescents and adults, considering varying social determinants. This study aimed to assess economic inequality in sexual health using intersectional approaches. Method: First manuscript: Data from the 2019 National Survey of School Health (PeNSE) included 146,343 adolescents (13–17 years), analyzing early sexual initiation (ESI), double protection (DP), and HPV vaccination (HPVv). Variables: sex, skin color, school type, residence, and wealth index. Mean difference from the national average (MDM) and slope index of inequality (SII) was employed. Second manuscript: The 2019 National Health Survey (PNS) data involved 80,386 adults (aged 25 years or older), exploring ESI and inconsistent condom use. Variables: sex, skin color, relationship status, sexual orientation, residence, and education level. To educational inequality we employed difference (D), ratio (R), and SII. Main findings: First manuscript: Black boys presented a risky pattern with significant wealth inequality (MDM ESI: 4.8 p.p.; MDM DP: 3.1 p.p.; SII HPVv: -19.1 p.p.). Girls living in rural areas (MDM ESI: 5.8 p.p.), studying in private schools (SII ESI: 7.3 p.p.), and white-skinned (MDM DP: 3.7 p.p.) adopted more risky sexual behaviors and presented greater magnitude of wealth inequality. Second manuscript: Adults with lower education exhibited a higher prevalence of early sexual initiation, particularly among women (D: -8.0 p.p.). In contrast, inconsistent condom use was more frequent among individuals with higher education, especially among women (D: 19.4 p.p.) and those without an intimate partner (R: 2.08). A schooling gradient in risky sexual behaviors was identified across several categories. Early sexual initiation was notably more prevalent among less educated women (SII: -10.0 p.p.). Conversely, inconsistent condom use was more common among individuals with higher education, particularly among women (SII: 27.9 p.p.), individuals without an intimate partner (SII: 23.2 p.p.), and those who self-identified as White (SII: 22.7 p.p.). Conclusion: Significant disparities in wealth and educational attainment have been demonstrated to exert a substantial influence on sexual behaviors and HPV vaccination. In consideration of this phenomenon, there is an imperative for the formulation of policies and strategies that are targeted towards vulnerable populations. Treating sexual health as a cross-cutting issue, integrating it into various sectors of public policies, is imperative.