Marks Sarah J, Merchant Roland C, Clark Melissa A, Liu Tao, Rosenberger Joshua G, Bauermeister Jose, Mayer Kenneth H
1 Department of Emergency Medicine, Alpert Medical School, Brown University , Providence, Rhode Island.
2 Department of Epidemiology, School of Public Health, Brown University , Providence, Rhode Island.
AIDS Patient Care STDS. 2017 Nov;31(11):470-478. doi: 10.1089/apc.2017.0171.
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.
与男性发生性行为的年轻成年男性（YMSM）在美国的艾滋病毒感染率仍然是最高的群体之一。暴露前预防（PrEP）是一种有效且安全的预防艾滋病毒感染的方法；然而，尽管美国食品药品监督管理局已批准，但PrEP的使用率仍然很低，部分原因是存在结构性障碍，尤其是获得医疗保健服务方面的障碍。在本研究中，我们利用社交媒体招募了未感染艾滋病毒的18至24岁的黑人、西班牙裔和白人YMSM。参与者完成了一项关于他们性行为、医疗保健服务获取情况以及之前PrEP使用情况的在线调查。在接受调查的2297名YMSM中，只有3.4%的人使用过PrEP。PrEP的使用与较高的教育水平、独居、年龄较大、较高的性活动水平以及更好的医疗保健服务获取情况相关，特别是拥有医疗保险以及有为他们提供治疗的诊所或初级保健提供者（PCP）。在未使用PrEP的人群中，65%的人至少符合美国疾病控制与预防中心推荐的一项PrEP使用指征，其中59%的人拥有医疗保险，在诊所接受治疗和/或有一名PCP。多变量多项逻辑回归模型确定了在获取医疗保健服务方面存在的年龄、种族/族裔、教育程度和地区差异。具体而言，年龄较大的YMSM、黑人和西班牙裔、正规教育年限较少的人以及美国南部和西部的居民更有可能缺乏医疗保健服务获取途径。这些结果表明了在YMSM中扩大PrEP使用规模的潜在机会和障碍。
