风险认知的重要性：基于社区的健康服务中泰国男男性行为者和变性女性对暴露前预防（PrEP）的接受度预测因素
Importance of Risk Perception: Predictors of PrEP Acceptance Among Thai MSM and TG Women at a Community-Based Health Service.
作者信息
Plotzker Rosalyn, Seekaew Pich, Jantarapakde Jureeporn, Pengnonyang Supabhorn, Trachunthong Deondara, Linjongrat Danai, Janyam Surang, Nakpor Thitiyanun, Charoenying Sutinee, Mills Stephen, Vannakit Ravipa, Cassell Michael, Phanuphak Praphan, Lertpiriyasuwat Cheewanan, Phanuphak Nittaya
机构信息
*Mount Sinai Hospital, New York, NY; †Thai Red Cross AIDS Research Centre, Bangkok, Thailand; ‡Rainbow Sky Association of Thailand, Bangkok, Thailand; §Service Workers In Group Foundation, Bangkok, Thailand; ‖Sisters Foundation, Chonburi, Thailand; ¶FHI 360 and USAID LINKAGES Project, Bangkok, Thailand; #Office of Public Health, U.S. Agency for International Development Regional Development Mission Asia, Bangkok, Thailand; and **Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
出版信息
J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):473-481. doi: 10.1097/QAI.0000000000001536.
BACKGROUND
HIV prevalence among Thai men who have sex with men (MSM) and transgender women (TG) are 9.15% and 11.8%, respectively, compared with 1.1% in the general population. To better understand early adopters of pre-exposure prophylaxis (PrEP) in Thailand, we analyzed biobehavioral and sociodemographic characteristics of PrEP-eligible MSM and TG.
SETTING
Four Thai urban community clinics between October 2015 and February 2016.
METHODS
Sociodemographics, HIV risk characteristics, and PrEP knowledge and attitudes were analyzed in association with PrEP initiation among eligible Thai MSM and TG. Adjusted analysis explored factors associated with PrEP acceptance. We then analyzed HIV risk perception, which was strongly associated with PrEP initiation.
RESULTS
Of 297 participants, 55% accepted PrEP (48% of MSM, 54% of TG). Perceived HIV risk levels were associated with PrEP acceptance [odds ratio (OR): 4.3; 95% confidence interval (95% CI): 1.5 to 12.2. OR: 6.3; 95% CI: 2.1 to 19.0. OR: 14.7; 95% CI: 3.9 to 55.1; for minimal, moderate, and high perceived risks, respectively]. HIV risk perception was associated with previous HIV testing (OR: 2.2; 95% CI: 1.4 to 3.5); inconsistent condom use (OR: 1.8; 95% CI: 1.1 to 2.9); amphetamine use in the past 6 months (OR: 3.1; 95% CI: 1.1 to 8.6); and uncertainty in the sexually transmitted infection history (OR: 2.3; 95% CI: 1.4 to 3.7). Approximately half of those who reported either inconsistent condom use (46%), multiple partners (50%), group sex (48%), or had baseline bacterial sexually transmitted infection (48%) perceived themselves as having no or mild HIV risk.
CONCLUSIONS
HIV risk perception plays an important role in PrEP acceptance. Perception does not consistently reflect actual risk. It is therefore critical to assess a client's risk perception and provide education about HIV risk factors that will improve the accuracy of perceived HIV risk.
背景
泰国男男性行为者（MSM）和变性女性（TG）中的艾滋病毒流行率分别为9.15%和11.8%，而普通人群中的流行率为1.1%。为了更好地了解泰国暴露前预防（PrEP）的早期采用者，我们分析了符合PrEP条件的MSM和TG的生物行为和社会人口学特征。
地点
2015年10月至2016年2月期间的四家泰国城市社区诊所。
方法
分析了符合条件的泰国MSM和TG的社会人口学、艾滋病毒风险特征以及PrEP知识和态度与开始使用PrEP之间的关联。调整后的分析探讨了与接受PrEP相关的因素。然后，我们分析了与开始使用PrEP密切相关的艾滋病毒风险认知。
结果
在297名参与者中，55%接受了PrEP（MSM中的48%，TG中的54%）。感知到的艾滋病毒风险水平与接受PrEP相关 [比值比（OR）：4.3；95%置信区间（95%CI）：1.5至12.2。OR：6.3；95%CI：2.1至19.0。OR：14.7；95%CI：3.9至55.1；分别对应最低、中度和高度感知风险]。艾滋病毒风险认知与以前的艾滋病毒检测相关（OR：2.2；95%CI：1.4至3.5）；不坚持使用避孕套（OR：1.8；95%CI：1.1至2.9）；在过去6个月内使用过安非他明（OR：3.1；95%CI：1.1至8.6）；以及性传播感染史不确定（OR：2.3；95%CI：1.4至3.7）。报告有不坚持使用避孕套（46%）、多个性伴侣（50%）、群交（48%）或基线细菌性性传播感染（48%）的人中，约一半认为自己没有或只有轻微的艾滋病毒风险。
结论
艾滋病毒风险认知在接受PrEP方面起着重要作用。认知并不总是反映实际风险。因此，评估客户的风险认知并提供关于艾滋病毒风险因素的教育，以提高对艾滋病毒风险感知的准确性至关重要。
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