Blair Kevin J, Torres Thiago S, Hoagland Brenda, Bezerra Daniel R B, Veloso Valdilea G, Grinsztejn Beatriz, Clark Jesse, Luz Paula M
South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
Department of Surgery, UCLA, 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA 90095, USA.
Lancet Reg Health Am. 2022 Feb;6. doi: 10.1016/j.lana.2021.100152. Epub 2021 Dec 23.
Pre-exposure prophylaxis (PrEP) use in Brazil remains low despite free national access. We explored associations of HIV knowledge and internalized homonegativity with PrEP use among PrEP-eligible men who have sex with men (MSM).
Brazilian users completed an online, cross-sectional survey in February-March 2020. We included cis-men ≥18 years old who reported recent sex with men and were PrEP-eligible per the following: condomless anal intercourse, partner(s) living with HIV, transactional sex, and/or sexually transmitted infection. Our outcome was current PrEP use, defined by the response, "I am currently taking PrEP." Key predictors included the HIV/AIDS Knowledge Assessment (HIV-KA) and Reactions to Homosexuality Scale (RHS); higher scores indicate greater knowledge and greater internalized homonegativity, respectively. Scales were standardized for analysis. Associations with current PrEP use were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).
Among 2398 PrEP-eligible MSM, = 370 (15·4%) reported current PrEP use. Increasing HIV-KA scores were associated with greater odds of PrEP use (aOR 1·70 [95%CI 1·41-2·04], < 0·001), and increasing RHS scores with lower odds of PrEP use (aOR 0·83 [95%CI 0·73-0·96], = 0·010). PrEP use was lower among 18-24 versus 40+-years-old MSM (aOR 0·43 [95%CI 0·27-0·69], = 0·005), and in Black versus White/Asian respondents (aOR 0·51 [95%CI 0·31-0·85], = 0·040).
Among PrEP-eligible Brazilian MSM, HIV knowledge was associated with increased PrEP use and internalized homonegativity with decreased use. Wider dissemination of HIV prevention knowledge and addressing stigma experienced by MSM could promote increased PrEP use.
National Institute of Mental Health, Fiocruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico.
尽管巴西可免费获取暴露前预防（PrEP）药物，但该国的PrEP使用率仍然很低。我们探讨了HIV知识及内化性消极观念与符合PrEP使用条件的男男性行为者（MSM）使用PrEP之间的关联。
2020年2月至3月，巴西的使用者完成了一项在线横断面调查。我们纳入了年龄≥18岁的顺性别男性，他们报告近期与男性发生过性行为，并且符合以下PrEP使用条件：无保护肛交、伴侣感染HIV、交易性行为和/或性传播感染。我们的研究结果是当前是否使用PrEP，通过回答“我目前正在服用PrEP”来定义。主要预测因素包括HIV/艾滋病知识评估（HIV-KA）和同性恋反应量表（RHS）；得分越高分别表明知识越丰富和内化性消极观念越强。为便于分析，量表进行了标准化处理。使用校正比值比（aOR）及95%置信区间（95%CI）估计与当前PrEP使用的关联。
在2398名符合PrEP使用条件的MSM中，370人（15.4%）报告目前正在使用PrEP。HIV-KA得分越高，使用PrEP的几率越大（aOR 1.70 [95%CI 1.41 - 2.04]，P<0.001），而RHS得分越高，使用PrEP的几率越低（aOR 0.83 [95%CI 0.73 - 0.96]，P = 0.010）。18 - 24岁的MSM中PrEP使用率低于40岁及以上的MSM（aOR 0.43 [95%CI 0.27 - 0.69]，P = 0.005），黑人受访者中的PrEP使用率低于白人/亚洲受访者（aOR 0.51 [95%CI 0.31 - 0.85]，P = 0.040）。
在符合PrEP使用条件的巴西MSM中，HIV知识与PrEP使用增加相关，而内化性消极观念与PrEP使用减少相关。更广泛地传播HIV预防知识并解决MSM所经历的污名化问题可能会促进PrEP使用的增加。
美国国立精神卫生研究所、巴西奥斯瓦尔多·克鲁兹基金会、巴西国家科学技术发展委员会。
