旧金山男男性行为者对 HIV-1 暴露前预防用药的模糊性、矛盾心理和担忧：一项混合方法研究。
Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study.
机构信息
University of California San Francisco, San Francisco, California, United States of America.
出版信息
PLoS One. 2012;7(11):e50061. doi: 10.1371/journal.pone.0050061. Epub 2012 Nov 14.
OBJECTIVE
We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIV-positive) male couples' PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.
DESIGN
Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants' awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it.
METHODS
We used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes.
RESULTS
Among 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIV-negative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse.
CONCLUSIONS
Findings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact.
目的
我们开展了一项混合方法研究，以调查血清不一致和血清一致（HIV 阳性/HIV 阳性）男性伴侣对 PrEP 的认知、对医疗保健提供者向社区提供 PrEP 的担忧，以及与伴侣中 HIV 阴性一方接受 PrEP 的相关性。
设计
定性子研究包括一对一访谈，以更深入地了解参与者对 PrEP 的认知和经验，以及对医疗保健提供者向男男性接触者（MSM）提供 PrEP 的担忧。定量分析包括一项横断面研究，其中要求参与者回答关于伴侣中 HIV 阴性一方接受 PrEP 的可能性，以及对医疗保健提供者向任何有需求的人提供 PrEP 的认同程度。
方法
我们使用多变量回归分析来检查 PrEP 问题与感兴趣的协变量之间的关联，并采用归纳法来确定关键的定性主题。
结果
在 328 名男性（164 对伴侣）中，62%听说过 PrEP，但约四分之一的人将其与暴露后预防混淆。大多数参与者对接受 PrEP 的意愿较低，40%不确定医疗保健提供者是否应该向任何有需求的人提供 PrEP。对 32 名男性的定性访谈表明，这种不确定性可能源于对增加风险补偿的担忧。伴侣中 HIV 阴性一方未来接受 PrEP 的可能性与无保护插入性肛交呈正相关，但与无保护接受性肛交呈负相关。
结论
研究结果表明，那些处于最大风险的人可能不接受 PrEP。那些从事中度风险行为的人对 PrEP 更感兴趣；然而，许多人表示担心在使用 PrEP 的同时增加风险行为。结果表明，需要进一步教育 MSM 社区，并确定可以使 PrEP 产生最大影响的适当人群。
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