男男性行为黑人中的医疗保健歧视、性行为披露与暴露前预防意识
Health Care Discrimination, Sex Behavior Disclosure, and Awareness of Pre-Exposure Prophylaxis Among Black Men Who Have Sex With Men.
作者信息
Maksut Jessica L, Eaton Lisa A, Siembida Elizabeth J, Fabius Chanee D, Bradley Alison M
机构信息
Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT.
Institute for Collaboration on Health, Policy, and Intervention (InCHIP), University of Connecticut, Storrs Mansfield, CT.
出版信息
Stigma Health. 2018 Nov;3(4):330-337. doi: 10.1037/sah0000102. Epub 2017 Sep 18.
BACKGROUND
Perceived healthcare-related discrimination and disclosure of same-sex sex behaviors to healthcare providers may act as barriers to awareness of pre-exposure prophylaxis (PrEP) for Black/African-American men who have sex with men (BMSM). Given the elevated rates of HIV transmission among young BMSM in particular, age is likely an important factor for determining the correlates of PrEP awareness unique to BMSM of different ages.
METHOD
147 BMSM ( age = 30.6 years, = 10.3 years) located in the Southeastern United States were recruited from gay-identified bars, clubs, bathhouses, parks, and street locations, via online classifieds (e.g., Craigslist) and social media (e.g., Facebook). Participants completed surveys that included questions about demographic characteristics, perceived healthcare-related discrimination, disclosure of same-sex sex behavior to healthcare providers, and PrEP awareness.
RESULTS
Perceived healthcare-related discrimination was significantly, negatively associated with PrEP awareness, and same-sex sex behavior disclosure to healthcare providers was significantly, positively related to awareness of PrEP among BMSM. A moderation analysis, with participant age as the moderator, revealed that higher perceived healthcare-related discrimination was significantly, negatively associated with PrEP awareness beginning at 30.2 years of age, and that the relationship strengthened as age increased.
DISCUSSION
Perceived healthcare-related discrimination plays a particularly important role in PrEP awareness for BMSM who are 30 years of age and older. Discrimination in healthcare settings may impact BMSM's ability, particularly those who are older, to access PrEP information. Healthcare professionals must establish procedures for identifying appropriate patients for PrEP, and prioritize addressing the psychosocial factors that impede PrEP awareness for their BMSM patients.
背景
感知到的与医疗保健相关的歧视以及向医疗保健提供者披露同性性行为可能成为男男性行为的黑人/非裔美国男性（BMSM）了解暴露前预防（PrEP）的障碍。鉴于特别是年轻BMSM中艾滋病毒传播率较高，年龄可能是确定不同年龄BMSM中PrEP知晓率相关因素的一个重要因素。
方法
从美国东南部的同性恋酒吧、俱乐部、澡堂、公园和街头地点，通过在线分类广告（如克雷格列表网）和社交媒体（如脸书）招募了147名BMSM（年龄 = 30.6岁，标准差 = 10.3岁）。参与者完成了调查问卷，其中包括有关人口统计学特征、感知到的与医疗保健相关歧视、向医疗保健提供者披露同性性行为以及PrEP知晓率的问题。
结果
感知到的与医疗保健相关歧视与PrEP知晓率显著负相关，向医疗保健提供者披露同性性行为与BMSM中的PrEP知晓率显著正相关。以参与者年龄作为调节变量的调节分析显示，从30.2岁开始，较高的感知到的与医疗保健相关歧视与PrEP知晓率显著负相关，并且这种关系随着年龄增长而增强。
讨论
感知到的与医疗保健相关歧视在30岁及以上的BMSM的PrEP知晓率中起着特别重要的作用。医疗保健环境中的歧视可能会影响BMSM，特别是年龄较大者获取PrEP信息的能力。医疗保健专业人员必须建立程序，以确定适合接受PrEP的患者，并优先解决阻碍其BMSM患者了解PrEP的心理社会因素。
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