Taylor Tonya N, DeHovitz Jack, Hirshfield Sabina
SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
Front Public Health. 2020 Jan 10;7:373. doi: 10.3389/fpubh.2019.00373. eCollection 2019.
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
检测是进入艾滋病病毒护理连续统一体的切入点，该连续统一体包括与预防服务的联系和持续参与，以及对预防策略的坚持，包括重复进行艾滋病病毒检测。尽管美国采取政策措施将艾滋病病毒检测扩展到不同的临床护理和社区环境，但黑人人群在艾滋病病毒检测方面的差异仍然存在。与美国出生的黑人相比，来自加勒比地区的外国出生（FB）黑人每年的艾滋病病毒诊断率更高，晚期艾滋病病毒诊断的比例也更高；而且FB黑人中的大多数艾滋病病毒感染发生在男性中。在本文中，我们概述了从事艾滋病病毒风险行为（例如，与艾滋病毒血清状况不明的男性和/或女性伴侣进行无保护性行为）的FB黑人男性在艾滋病病毒检测方面的障碍。FB和美国出生的黑人男性在艾滋病病毒检测方面的障碍包括艾滋病病毒污名（预期的、感知到的、内化的）、感知到的艾滋病病毒风险低、对医疗或政府的不信任，以及认为获取检测资源的机会少。我们研究了有关男性气质和性别角色的观念，这些观念可能使与低艾滋病病毒风险认知和艾滋病病毒检测障碍相关的异性恋规范刻板印象长期存在。我们还讨论了近期移民政策对获取艾滋病病毒检测和治疗服务的影响，以及交叉污名和结构性压迫形式，如种族主义、对特定移民群体的偏见和恐同症，这些可能会进一步加剧FB黑人男性在艾滋病病毒检测方面的障碍。最后，我们回顾了全面的预防方法，并提出了可能提高FB黑人男性艾滋病病毒检测接受率的创新方法。
