Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
University of Victoria, Victoria, BC, Canada.
Qual Health Res. 2022 Jul;32(8-9):1315-1327. doi: 10.1177/10497323221092701. Epub 2022 May 26.
The PrEP Cascade is a dominant framework for investigating barriers to HIV pre-exposure prophylaxis (PrEP), an HIV prevention tool. We interviewed 37 PrEP users and 8 non-PrEP users in Ontario and British Columbia, Canada, about their decision-making through the Cascade. Participants were HIV-negative gay, bisexual, and queer men (GBQM). The data were analyzed using thematic analysis. PrEP decision-making was based on pragmatic considerations (logistics, costs, and systemic barriers), biomedical considerations (efficacy, side-effects, and sexually transmitted infections), and subjective considerations (identity, politics, and changing sexual preferences). Affective attachments to established versions of "safer sex" (condoms and serosorting) made some GBQM less likely to try PrEP. Some GBQM expressed increased social expectations to use PrEP, have condomless sex, and serodifferent sex. These findings support offering PrEP at no-cost, offering individualized counseling and community-based opportunities to discuss PrEP use and changing sexual practices, and improving communication on the manageability of PrEP side-effects.
暴露前预防（PrEP）是一种艾滋病预防工具，预防艾滋病连续体是研究 HIV 暴露前预防（PrEP）障碍的主要框架。我们对加拿大安大略省和不列颠哥伦比亚省的 37 名 PrEP 用户和 8 名非 PrEP 用户进行了访谈，了解他们通过连续体进行决策的情况。参与者为 HIV 阴性的男同性恋、双性恋和酷儿（GBQM）。使用主题分析对数据进行了分析。PrEP 决策基于实际考虑因素（后勤、成本和系统障碍）、生物医学考虑因素（疗效、副作用和性传播感染）以及主观考虑因素（身份、政治和性偏好变化）。对既定的“安全性行为”（避孕套和血清学选择）的情感依恋使一些 GBQM 不太可能尝试 PrEP。一些 GBQM 表示，他们对使用 PrEP、无保护措施的性行为和血清不同的性行为的社会期望增加。这些发现支持免费提供 PrEP，提供个性化咨询和基于社区的机会，讨论 PrEP 的使用和性行为的变化，并改善关于 PrEP 副作用的可管理性的沟通。
