Ayala George, Makofane Keletso, Santos Glenn-Milo, Beck Jack, Do Tri D, Hebert Pato, Wilson Patrick A, Pyun Thomas, Arreola Sonya
The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA ; San Francisco Department of Public Health, San Francisco, CA, USA.
J Sex Transm Dis. 2013;2013:953123. doi: 10.1155/2013/953123. Epub 2013 Jul 8.
Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.
引言。在全球范围内，男男性行为者（MSM）受艾滋病毒的影响尤为严重。需要有易于获得的、针对男男性行为者需求的综合艾滋病毒预防策略，以有效应对艾滋病疫情。方法与材料。2012年4月至8月，我们对来自145个国家的男男性行为者（n = 3748）进行了一项横断面研究。我们使用多变量随机效应模型，研究了与暴露前预防（PrEP）的可接受性以及获得避孕套、润滑剂、艾滋病毒检测和艾滋病毒治疗相关的因素。结果。分别有35%和22%的受访者能够获得避孕套和润滑剂。35%的艾滋病毒阴性受访者能够获得艾滋病毒检测。所有艾滋病毒阳性受访者中有43%报告称抗逆转录病毒疗法很容易获得。恐同、出柜情况以及服务提供者的污名化与获得服务的机会减少显著相关。相反，社区参与、与同性恋社区的联系以及与服务提供者相处融洽则与获得服务的机会增加相关。PrEP的可接受性与较低的PrEP相关污名、对PrEP的了解较少、出柜情况较少、较高的服务提供者污名以及因身为男男性行为者而遭受暴力有关。结论。确保男男性行为者获得艾滋病毒服务对于最大限度地提高综合方法的潜在有效性至关重要，特别是考虑到PrEP等基本干预措施和新干预措施之间的相互依存关系。应更好地了解并解决男男性行为者获得艾滋病毒服务的障碍和促进因素。
