School of Social Work, University of Michigan, Ann Arbor, MI, USA.
University of Michigan School of Social Work, Room 2850, 1080 South University, Ann Arbor, MI, 48109, USA.
AIDS Behav. 2018 Nov;22(11):3681-3691. doi: 10.1007/s10461-018-2184-4.
There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007-2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The "purview paradox" was identified as a key barrier-HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.
在美国，获得 PrEP 存在诸多挑战，因此采用率较低。本综述（2007-2017 年）对 PrEP 的实施情况进行了分析，确定了 PrEP 面临的障碍和与之匹配的干预措施。最终纳入的文章（n=47）包含了有关 HIV 服务提供者和感染风险个体认知方面的内容、综述和案例研究。针对患者和医护人员的认知障碍和干预措施包括对 PrEP 的了解、态度和信念。“权限悖论”被确定为一个关键障碍——HIV 专家通常不看 HIV 阴性患者，而经常看未感染患者的初级保健医生没有接受过提供 PrEP 的培训。医疗保健系统的障碍包括缺乏关于 PrEP 的沟通、资金和获取途径。还确定了 PrEP 污名、HIV 污名、跨性别恐惧症、同性恋恐惧症以及性别、种族和族裔群体之间的差异之间的交集；但很少有干预措施能够解决这些障碍。我们建议采取多层面的干预措施，针对多个社会生态领域的障碍。
