Allan-Blitz Lao-Tzu, Mena Leandro A, Mayer Kenneth H
Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Mhealth. 2021 Apr 20;7:33. doi: 10.21037/mhealth-20-42. eCollection 2021.
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
在美国，除了年轻人，尤其是黑人及拉丁裔男男性行为者（MSM）中的人类免疫缺陷病毒（HIV）感染率总体呈下降趋势。在本综述中，我们总结了青年人群中HIV流行的关键驱动因素，以及专门针对高危人群抗击该流行病的新型干预措施。导致青年人群中HIV流行的许多因素都与系统性不平等有关，包括难以获得医疗保健、教育不足以及内化的恐同和种族主义经历。从发展角度来看，年轻人可能觉得自己不会受到伤害，因而愿意冒险。此外，鉴于治疗方面的进展和社区污名化，HIV对年轻人来说往往是无形的，这限制了对风险和新预防方式的公开讨论。HIV治疗级联反应的结果表明，与年长的男男性行为者和其他HIV感染者群体相比，年轻人不太可能知晓自己的HIV感染状况，不太可能接受并参与治疗，且病毒学抑制的可能性也较小。重要的是，暴露前预防（PrEP）已被证明是预防HIV感染的有效工具，但在年轻人中的使用率似乎特别低。PrEP使用的障碍似乎非常多样化，包括患者层面、提供者层面和结构层面的障碍。因此，改善HIV预防的干预措施必须是多方面的，并针对文化多元的人群制定。基于认知行为疗法的干预措施是很有前景的策略，因为它们能够解决各种各样的障碍。PrEP的新配方也可能有助于提高依从性。由于年轻人花大量时间使用数字媒体，应用程序和其他基于手机的界面的应用为增加教育和促进对高危青年的HIV预防提供了独特机会。目前正在进行多项研究，以更好地为这个复杂多样的人群提供最佳的治疗和预防服务，其中包括新型社会生物学干预措施和新的药物递送方式，这些措施可能有助于克服年轻人特有的障碍。
