Department of Biostatistics & Epidemiology, Rutgers School of Public Health, 683 Hoes Ln W, Piscataway, NJ, 08854, USA.
Rutgers School of Social Work, New Brunswick, NJ, USA.
AIDS Behav. 2021 Nov;25(11):3574-3604. doi: 10.1007/s10461-021-03262-4. Epub 2021 Apr 18.
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
鉴于艾滋病预防和治疗方面的最新进展,我们回顾了文献,以了解不同类型的耻辱感如何影响男男性行为者(MSM)的艾滋病风险;获得艾滋病预防、护理和治疗服务;以及相关的健康结果。我们对观察性和定性研究进行了范围广泛的文献综述,这些研究检查了 MSM 中的耻辱感和与艾滋病相关的结果。我们的搜索确定了 5794 项研究,其中 47 项符合资格标准并包含在最终分析中。该综述表明,耻辱感仍然是艾滋病毒阴性和艾滋病毒阳性 MSM 参与艾滋病预防和治疗的一个巨大障碍。在对艾滋病毒阳性 MSM 的研究中,内化的耻辱感与较低的治疗参与度有关。美国南部的艾滋病毒阳性 MSM 也更有可能进行危险的性行为。感知到的医疗保健歧视与 PrEP 意识呈负相关,尤其是在艾滋病毒阴性的黑人 MSM 中。在有色人种的年轻 MSM 中,交叉性耻辱感加剧了接受 PrEP 治疗的社会结构性障碍。研究结果表明,应该在不同的 MSM 社区中实施减少耻辱感的干预措施,以解决与护理连续体中关键差距相关的不成比例的艾滋病负担。进一步的研究应该检查包括交叉性耻辱感在内的各种类型的耻辱感如何影响病毒抑制和 PrEP 的采用和坚持,尤其是在有色人种的 MSM 中。
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