“Como conseguir a sua Doxi-PEP?”: vulnerabilidades e rotas críticas encontradas por homens no itinerário terapêutico no Brasil

This study aimed to investigate the context of doxycycline-based post-exposure prophylaxis (Doxy-PEP) use for the prevention of sexually transmitted infections (STIs) by men who have sex with men (MSM) in Brazil. A qualitative study was conducted with 32 MSM participants, selected on social media. Data was collected by online questionnaires, which included open-ended questions about experiences with Doxy-PEP, access to medications, and interactions with the health care system. Responses were analyzed using the IRaMuTeQ program for descending hierarchical classification and reflective thematic analysis. The results revealed three main categories: (1) access to and management of post-exposure prophylaxis, in which participants reported difficulties in obtaining Doxy-PEP due to prescribing restrictions and lack of information; (2) perceptions and knowledge on risks and prevention, which highlighted a mix of knowledge and misinformation about STIs and prevention strategies; (3) social and behavioral dynamics, demonstrating how social interactions and stigma influence prevention practices. The study also indicated self-medication and drug storage as common practices. The study identified multiple barriers to access and management of Doxy-PEP among MSM in Brazil, influenced by individual, social, and programmatic factors. It is imperative to develop public health strategies that improve access to and information about Doxy-PEP among MSM, as well as approaches that reduce STIs-associated stigma.