Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Prev Med. 2020 Aug;59(2):e79-e87. doi: 10.1016/j.amepre.2020.02.010. Epub 2020 May 4.
Stigma impairs access to health care by gay, bisexual, and other men who have sex with men. Gay, bisexual, and other men who have sex with men who are open about their sexuality, or out, are more resilient to stigma than those who are not out. Outness may influence healthcare utilization and prescription of HIV pre-exposure prophylaxis to HIV-negative gay, bisexual, and other men who have sex with men.
Analyzing the 2018 American Men's Internet Survey during 2019, the adjusted prevalence ratios of healthcare stigmas and outness to healthcare providers were calculated. The effect of outness on annual healthcare visits and stigma was measured. Pre-exposure prophylaxis seeking and denial by providers was quantified and stratified by outness.
Of 5,794 respondents, 3,402 (58.7%) were out to their provider. Out gay, bisexual, and other men who have sex with men were less likely to experience anticipated stigma (adjusted prevalence ratio=0.75, 95% CI=0.72, 0.80) but more likely to experience enacted stigma or discrimination (adjusted prevalence ratio=1.23, 95% CI=1.18, 1.28). In a subsample of out gay, bisexual, and other men who have sex with men, recently experienced discrimination was associated with higher healthcare utilization (adjusted prevalence ratio=1.51, 95% CI=1.14, 1.51). Conversely, recent experienced discrimination was associated with lower healthcare utilization in not out gay, bisexual, and other men who have sex with men (adjusted prevalence ratio=0.67, 95% CI=0.54, 0.82). Of 3,104 out gay, bisexual, and other men who have sex with men, 1,417 (45.7%) discussed pre-exposure prophylaxis with their providers, compared with 120 of 1,711 (7.0%) gay, bisexual, and other men who have sex with men who were not out (p<0.001). Pre-exposure prophylaxis denials were less common among out (116/793, 14.6%) than not out (14/55, 25.5%) gay, bisexual, and other men who have sex with men (p=0.044).
Healthcare provider-related stigmas impair healthcare engagement among not out gay, bisexual, and other men who have sex with men who were also more commonly denied pre-exposure prophylaxis. Ending the HIV epidemic necessitates creating safe environments for disclosure of sexual preferences and practices to facilitate access to HIV prevention.
污名化会影响男同性恋者、双性恋者和其他与男性发生性行为者获得医疗保健的机会。与那些不公开自己性取向的男同性恋者、双性恋者和其他与男性发生性行为者相比，公开自己性取向的男同性恋者、双性恋者和其他与男性发生性行为者更能抵御污名化。公开自己的性取向可能会影响男同性恋者、双性恋者和其他与男性发生性行为者寻求医疗保健服务的意愿和医生为他们开具艾滋病毒暴露前预防药物的意愿。
在 2019 年分析了 2018 年美国男性互联网调查，计算了医疗保健污名和对医疗服务提供者的公开程度与医疗保健提供者之间的调整后患病率比。衡量了公开程度对年度医疗保健就诊次数和污名的影响。通过对公开程度进行分层，量化了提供者对艾滋病毒暴露前预防药物的寻求和拒绝情况。
在 5794 名受访者中，有 3402 名（58.7%）向医疗服务提供者公开了自己的性取向。公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者不太可能经历预期的污名化（调整后患病率比=0.75，95%置信区间=0.72，0.80），但更有可能经历实际的污名化或歧视（调整后患病率比=1.23，95%置信区间=1.18，1.28）。在公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者的一个子样本中，最近经历的歧视与更高的医疗保健利用率相关（调整后患病率比=1.51，95%置信区间=1.14，1.51）。相反，最近经历的歧视与未公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者的医疗保健利用率较低有关（调整后患病率比=0.67，95%置信区间=0.54，0.82）。在 3104 名公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者中，有 1417 名（45.7%）与医疗服务提供者讨论了艾滋病毒暴露前预防药物，而在 1711 名未公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者中，有 120 名（7.0%）讨论了艾滋病毒暴露前预防药物（p<0.001）。与未公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者相比，公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者的艾滋病毒暴露前预防药物拒绝率较低（公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者：116/793，14.6%；未公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者：14/55，25.5%）（p=0.044）。
与未公开性取向的男同性恋者、双性恋者和其他与男性发生性行为者相比，与医疗服务提供者相关的污名化会影响他们的医疗保健参与度，这些男同性恋者、双性恋者和其他与男性发生性行为者也更有可能被拒绝提供艾滋病毒暴露前预防药物。要想终结艾滋病毒流行，就必须为公开性取向和性行为创造安全的环境，以促进获得艾滋病毒预防措施。
