Department of Health Science, University of Alabama, Tuscaloosa, AL 35401, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, USA; Center for Drug Use and HIV/HCV Research, New York, NY, USA.
Department of Health Science, University of Alabama, Tuscaloosa, AL 35401, USA.
J Subst Abuse Treat. 2021 Oct;129:108371. doi: 10.1016/j.jsat.2021.108371. Epub 2021 Mar 17.
HIV prevention is needed among people who use drugs (PWUD) due to mixing sex and drugs, selling/trading sex, and/or injecting drugs. Pre-exposure prophylaxis (PrEP) is an extremely effective biomedical HIV prevention strategy, but uptake remains low among communities most in need of HIV prevention, including PWUD. Previous studies have found that providers are less willing to prescribe PrEP to PWUD, yet PWUD express high levels of PrEP acceptance. More research is needed to understand how people who provide substance use treatment services think about PrEP to maximize this biomedical prevention strategy.
The study conducted semistructured interviews with 29 staff members in two methadone clinic settings in urban northern New Jersey. Staff members included medical providers, methadone counselors, intake coordinators, front desk staff, lab technicians, security guards, and administrative/leadership personnel.
All staff recognized the need for HIV prevention among their patient populations, but most were either unaware of PrEP or unfamiliar with its purpose and how it works. Medical providers were more likely to have some PrEP knowledge in comparison to counselors and other staff, but the former largely did not have in-depth knowledge. Among those familiar with PrEP, many confused PrEP with HIV medication, as Truvada was the only FDA-approved PrEP at the time of the study. About half of participants expressed clear support for PrEP, while the other half expressed mixed or negative attitudes related to HIV, sexual behavior, and mistrust of the medication. Both the positive and negative perceptions entailed stigmatizing elements.
Due to patients' frequent interactions with non-medical staff (e.g., front desk staff, lab technicians, etc.), all staff, not only medical personnel, should be aware of PrEP and comfortable discussing it to foster well-informed, nonjudgmental conversations about HIV prevention with patients. PrEP education should specifically address HIV and sexual-related stigma, as even positive perceptions of PrEP may entail stigmatizing elements.
由于性行为和吸毒行为的混合、性交易以及/或注射吸毒，需要对吸毒者（PWUD）进行艾滋病预防。暴露前预防（PrEP）是一种非常有效的预防艾滋病毒的生物医学策略，但在最需要预防艾滋病毒的社区中，包括吸毒者，PrEP 的使用率仍然很低。先前的研究发现，提供者不太愿意为 PWUD 开 PrEP 处方，而 PWUD 则对 PrEP 表示高度接受。需要进一步研究，以了解提供药物滥用治疗服务的人员如何看待 PrEP，以最大限度地利用这一生物医学预防策略。
本研究对新泽西州北部两个美沙酮诊所的 29 名工作人员进行了半结构化访谈。工作人员包括医疗提供者、美沙酮顾问、入职协调员、前台工作人员、实验室技术人员、保安人员和行政/领导人员。
所有工作人员都认识到他们的患者群体需要预防艾滋病，但大多数人要么不知道 PrEP，要么不了解其目的和工作原理。与顾问和其他工作人员相比，医疗提供者更有可能了解一些 PrEP 知识，但前者在很大程度上没有深入了解。在熟悉 PrEP 的人中，许多人将 PrEP 与 HIV 药物混淆，因为当时 Truvada 是唯一获得 FDA 批准的 PrEP。大约一半的参与者明确表示支持 PrEP，而另一半则对 HIV、性行为和对药物的不信任表达了混合或负面的态度。这两种看法都包含污名化元素。
由于患者经常与非医疗人员（如前台工作人员、实验室技术人员等）互动，不仅医疗人员，所有工作人员都应该了解 PrEP，并能够舒适地讨论它，以促进与患者进行知情、无偏见的 HIV 预防对话。PrEP 教育应特别针对与 HIV 和性相关的污名，因为即使对 PrEP 的正面看法也可能包含污名化元素。
