Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago, Chicago, USA.
Department of Medicine, University of Chicago, Chicago, IL, USA.
Curr HIV/AIDS Rep. 2022 Aug;19(4):265-280. doi: 10.1007/s11904-022-00610-4. Epub 2022 Jul 6.
Status-neutral care, a person-centered approach to healthcare not predicated on HIV serostatus, may improve health equity among Black sexual minority men (BSMM). We reviewed current status-neutral, HIV, and Pre-Exposure Prophylaxis (PrEP) interventions, and coded each for social-ecological focus and use of six approaches: (1) person-centered, (2) anti-stigma, (3) social support, (4) the social determinants of health (SDOH), (5) community engagement, and (6) multi-sectoral partnerships.
We reviewed 25 studies, of which 3 were status-neutral. Nineteen studies utilized person-centered approaches, with several employing BSMM peers. For SDOH, financial incentives and reducing clinic-level barriers to care improved cascade outcomes. Direct text messaging, anti-stigma, social support, community-engagement, and multi-sectoral partnerships also improved outcomes in some studies. Few status-neutral programs exist and additional research is needed to identify key intervention components and mechanisms of influence. Programs targeting SDOH and multiple social-ecological levels offer promise for providing holistic care to BSMM, while addressing HIV prevention and treatment and health equity.
综述目的：不以 HIV 血清阳性状况为基础的、对所有人一视同仁的医疗护理方法，即以人为本的医疗方法，可能会提高黑人男同性恋者（BSMM）的健康公平性。我们回顾了目前的无差别护理、HIV 和暴露前预防（PrEP）干预措施，并为每一种干预措施进行了社会生态焦点编码，并使用了六种方法进行编码：（1）以人为本，（2）抗污名化，（3）社会支持，（4）健康的社会决定因素（SDOH），（5）社区参与，和（6）多部门合作。
最新发现：我们回顾了 25 项研究，其中 3 项是无差别的。19 项研究采用了以人为本的方法，其中一些研究采用了 BSMM 的同行。对于 SDOH，经济激励和减少诊所层面的护理障碍可以改善级联结果。直接短信、抗污名化、社会支持、社区参与和多部门合作也在一些研究中改善了结果。目前几乎没有无差别护理计划，需要进一步的研究来确定关键的干预措施组成部分和影响机制。针对 SDOH 和多个社会生态层面的计划为向 BSMM 提供全面护理提供了希望，同时解决了 HIV 预防和治疗以及健康公平问题。
