“我们去我们了解的地方”：动员人们接受 PrEP 和性健康（Mobilizing for PrEP and Sexual Health，简称 MobPrESH）的反思 - 这是一个在英格兰由女性和非二元性别者主导的 PrEP 教育项目。
'We go where we know': Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) - A peer-led PrEP education programme across England, for and by women and non-binary people.
机构信息
London School of Hygiene & Tropical Medicine, London, UK.
Independent Researcher, London, UK.
出版信息
Womens Health (Lond). 2022 Jan-Dec;18:17455057221091727. doi: 10.1177/17455057221091727.
BACKGROUND
Pre-exposure prophylaxis is a highly effective method of HIV prevention but few women know about it, have access to it, or see it as relevant to them. In 2019, grassroots organization PrEPster piloted a peer-led intervention, MobPrESH (Mobilizing for Pre-Exposure prophylaxis (PrEP) and Sexual Health), across three sites in England, to mobilize for PrEP and sexual health with communities of women and non-binary people most affected by HIV, including Black women and non-binary people, people of colour, migrants, and transgender (trans) women.
OBJECTIVES
We aimed to explore the accessibility, feasibility, acceptability, and 'fidelity' of MobPrESH, from the perspectives of peer mobilizers and project staff.
METHODS
We conducted focus group discussions and qualitative interviews with nine peer mobilizers (most identified as Black cisgender (cis) women) and six project staff (including Black and white cis women and non-binary people). We analysed data thematically, iteratively, and inductively, informed by concepts of reproductive and social justice.
RESULTS
We present findings in five thematic areas: connecting and relating to situate sexual health discussions, navigating silence and stigma, connecting within and across communities, competing pressures and structural hostilities, and resources and continuity. Community knowledge-building about PrEP is a slow, iterative process that needs investment and creation of trusted spaces that centre communities' needs and concerns. Peer mobilizers and the communities they engaged with had competing demands in their lives, and knowledge-raising about PrEP was impacted by intersecting stigmas, discrimination, and oppressions around HIV status, racism, misogyny, transphobia, homophobia, and anti-sex worker rhetoric.
CONCLUSIONS
Peer-led PrEP interventions require funding and foregrounding, particularly for women and non-binary people who are Black, trans, migrants, and people of colour, situated relative to their wider health needs, life pressures, and priorities. This requires concurrent challenge of the racist and patriarchal structures that continue to obscure the sexual and reproductive health needs of racially minoritized and marginalized women and non-binary people.
背景
暴露前预防（PrEP）是一种非常有效的 HIV 预防方法，但很少有女性了解它，也很少有女性能够获得 PrEP 或认为它与自己相关。2019 年，基层组织 PrEPster 在英格兰的三个地点试点了一项由同龄人领导的干预措施，即 MobPrESH（动员 PrEP 和性健康），旨在动员受 HIV 影响最大的女性和非二元人群（包括黑人女性和非二元人群、有色人种、移民和跨性别（跨）女性）了解 PrEP 和性健康。
目的
我们旨在从同龄人动员者和项目工作人员的角度探讨 MobPrESH 的可及性、可行性、可接受性和“保真度”。
方法
我们对 9 名同龄人动员者（大多数为黑人顺性别（cis）女性）和 6 名项目工作人员（包括黑人和白人顺性别女性和非二元性别者）进行了焦点小组讨论和定性访谈。我们采用主题分析方法，对数据进行迭代和归纳分析，这一方法受到生殖和社会公正概念的启发。
结果
我们从五个主题领域呈现研究结果：建立联系和关系以进行性健康讨论、在沉默和污名中进行导航、在社区内部和社区之间建立联系、竞争压力和结构性敌对、以及资源和连续性。关于 PrEP 的社区知识建设是一个缓慢的、迭代的过程，需要投资和创造信任空间，以满足社区的需求和关注。同龄人动员者和他们所接触的社区都面临着生活中的各种竞争需求，而关于 PrEP 的知识普及受到围绕 HIV 状况、种族主义、厌女症、跨性别恐惧症、同性恋恐惧症和反性工作者言论的交叉污名、歧视和压迫的影响。
结论
需要为同伴领导的 PrEP 干预措施提供资金和支持，特别是为黑人、跨性别、移民和有色人种的女性和非二元性别者提供资金和支持，这要考虑到他们更广泛的健康需求、生活压力和优先事项。这需要同时挑战继续掩盖少数族裔和边缘化女性和非二元性别者的性和生殖健康需求的种族主义和父权制结构。
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