Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.
Department of Epidemiology, Fielding School of Public Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
J Urban Health. 2017 Oct;94(5):710-715. doi: 10.1007/s11524-017-0172-z.
We assessed socio-structural and behavioral correlates of preexposure prophylaxis (PrEP) for HIV infection among a sample of high-risk HIV-negative men who have sex with men (MSM) in Los Angeles, California. Participants from an ongoing 5-year prospective cohort study investigating the direct impacts of substance use on HIV transmission dynamics were enrolled between February 2015 and January 2017. All men completed a computer-assisted self-interview every 6 months that assessed recent (past 6 months) PrEP use and socio-structural and behavioral factors. Of the total 185 MSM (mean age = 29 years) included in the study, majority were African American (40%) or Hispanic (41%) and reported current health insurance coverage (80%). In multivariable analysis using log-binomial regression, having health insurance coverage [adjusted prevalence ratio (aPR) 2.02; 95% confidence interval (CI) 1.01 to 4.01, p = 0.04] was associated with recent PrEP use. Unstable housing (aPR = 0.44, 95% CI 0.22 to 0.90, p = 0.02) was associated with lower PrEP use. Behavioral factors associated with recent PrEP use include sex with a HIV-positive partner (aPR = 3.63, 95% CI 1.45 to 9.10, p = 0.01), having six or more sex partners (aPR = 2.20, 95% CI 1.26 to 3.82, p = <0.01), and popper use (aPR = 2.76, 95% CI 1.58 to 4.84, p = <0.01). In this sample of predominantly racial/ethnic minority MSM, socio-structural and behavioral factors were important factors associated with recent PrEP use. These findings provide considerations for intervention development to promote PrEP use among key groups of MSM.
我们评估了在加利福尼亚州洛杉矶的一组高危 HIV 阴性男男性行为者 (MSM) 中，针对 HIV 感染的暴露前预防 (PrEP) 的社会结构和行为相关性。这项研究为一项为期 5 年的前瞻性队列研究的一部分，该研究旨在调查物质使用对 HIV 传播动力学的直接影响，于 2015 年 2 月至 2017 年 1 月期间招募参与者。所有男性每 6 个月完成一次计算机辅助的自我访谈，评估最近（过去 6 个月）PrEP 的使用情况以及社会结构和行为因素。在研究中，总共包括 185 名 MSM（平均年龄为 29 岁），其中大多数为非裔美国人（40%）或西班牙裔（41%），并报告了当前的医疗保险覆盖（80%）。在使用对数二项式回归的多变量分析中，医疗保险覆盖（调整后的患病率比 [aPR] 2.02；95%置信区间 [CI] 1.01 至 4.01，p=0.04）与最近 PrEP 的使用有关。不稳定的住房（aPR=0.44，95%CI 0.22 至 0.90，p=0.02）与 PrEP 的使用减少有关。与最近 PrEP 使用相关的行为因素包括与 HIV 阳性伴侣发生性行为（aPR=3.63，95%CI 1.45 至 9.10，p=0.01）、有 6 个或更多性伴侣（aPR=2.20，95%CI 1.26 至 3.82，p<0.01）和使用摇头丸（aPR=2.76，95%CI 1.58 至 4.84，p<0.01）。在这个以少数族裔为主的 MSM 样本中，社会结构和行为因素是与最近 PrEP 使用相关的重要因素。这些发现为促进关键 MSM 群体使用 PrEP 提供了干预措施制定的考虑因素。
