识别男男性行为者和男女双性恋男性（BMSMW）且感染艾滋病毒者接受常规护理和治疗的社会和经济障碍：来自Bruthas队列的定性研究
Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: a qualitative study from the Bruthas cohort.
作者信息
Arnold Emily A, Weeks John, Benjamin Michael, Stewart William R, Pollack Lance M, Kegeles Susan M, Operario Don
机构信息
University of California San Francisco, 550 16th Street, San Francisco, CA, 94114, USA.
CAL-PEP, 2811 Adeline St, Oakland, CA, 94612, USA.
出版信息
BMC Health Serv Res. 2017 Jan 28;17(1):90. doi: 10.1186/s12913-017-2011-z.
BACKGROUND
There is little research regarding the ability of Black men who have sex with men and women (BMSMW) to access and maintain HIV-related health care and treatment adherence. This population, who often insist on secrecy about their same-sex desire, may experience unique barriers to seeking regular care and treatment.
METHODS
From March 2011-April 2014, we recruited 396 BMSMW in the San Francisco Bay Area to be enrolled in our randomized controlled trial. At baseline we administered a behavioral survey assessing: demographics, homelessness, employment, history of incarceration, HIV status and disclosure practices, care and treatment adherence. 64 men reported living with HIV at intake. To learn more about their experiences, we recruited N = 25 to participate in qualitative interviews, which were conducted April-December 2014. Topics included: current living situation, diagnosis story, disclosure practices, experiences of accessing and maintaining care and treatment, and HIV-related stigma. Recordings were transcribed and coded for major themes.
RESULTS
Despite being located in an area where treatment is plentiful, men faced social and economic barriers to maintaining regular care and treatment adherence. Several findings emerged to shed light on this quandary: (1) Competing needs particularly around attaining stable housing, food security, and money created barriers to treatment and care; (2) Side effects of HIV medications discouraged men from adhering to treatment; (3) Provider and Institutional level characteristics influenced care engagement; (4) Disclosure and social support made a difference in care and treatment behaviors; and (5) Participants expressed a desire for group-based intervention activities to support treatment and care among HIV+ BMSMW. Inadequate engagement in the continuum of care for HIV was born out in the quantitative data where 28% of participants did not know their Viral Load.
CONCLUSIONS
A holistic approach to HIV health for BMSMW would appear to translate to better outcomes for men living with HIV, where a goal of viral suppression must also include attending to their basic social and economic support needs.
背景
关于双性恋黑人男性获得并维持与艾滋病病毒相关的医疗保健以及治疗依从性的能力，相关研究较少。这一群体常常坚持对其同性欲望保密，在寻求常规护理和治疗时可能会遇到独特的障碍。
方法
2011年3月至2014年4月，我们在旧金山湾区招募了396名双性恋黑人男性参与我们的随机对照试验。在基线时，我们进行了一项行为调查，评估内容包括：人口统计学特征、无家可归状况、就业情况、监禁史、艾滋病病毒感染状况及信息披露情况、护理及治疗依从性。64名男性在入组时报告感染了艾滋病病毒。为了更深入了解他们的经历，我们招募了N = 25名参与者进行定性访谈，访谈于2014年4月至12月进行。主题包括：当前生活状况、诊断经历、信息披露情况、获得并维持护理和治疗的经历以及与艾滋病病毒相关的耻辱感。对录音进行转录并编码以确定主要主题。
结果
尽管所在地区治疗资源丰富，但这些男性在维持常规护理和治疗依从性方面仍面临社会和经济障碍。有几个发现有助于阐明这一困境：（1）特别是在获得稳定住房、食品安全和资金方面的相互竞争的需求给治疗和护理造成了障碍；（2）艾滋病病毒药物的副作用使男性不愿坚持治疗；（3）提供者和机构层面的特征影响了护理参与度；（4）信息披露和社会支持对护理和治疗行为产生了影响；（5）参与者表示希望开展基于群体的干预活动，以支持感染艾滋病病毒的双性恋黑人男性的治疗和护理。在定量数据中，28%的参与者不知道自己的病毒载量，这表明他们在艾滋病病毒连续护理方面的参与不足。
结论
对双性恋黑人男性的艾滋病病毒健康采取整体方法似乎会为感染艾滋病病毒的男性带来更好的结果，其中病毒抑制的目标还必须包括满足他们基本的社会和经济支持需求。
Zotero 插件