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在减少美国的黑人和西班牙裔/拉丁裔顺性别性少数男性和跨性别女性中的 HIV 传播方面,PrEP 污名和后勤障碍仍然是重大挑战。

PrEP Stigma and logistical barriers remain significant challenges in curtailing HIV transmission among Black and Hispanic/Latinx cisgender sexual minority men and transgender women in the US.

机构信息

Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.

Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.

出版信息

AIDS Care. 2022 Nov;34(11):1465-1472. doi: 10.1080/09540121.2022.2098908. Epub 2022 Jul 17.

DOI:10.1080/09540121.2022.2098908
PMID:35848490
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9842805/
Abstract

Despite advancements in HIV prevention, such as pre-exposure prophylaxis (PrEP), there remain inequities in accessing PrEP among Black and Hispanic/Latinx cisgender sexual minority men and transgender women (SMMTW). Researchers have documented multiple barriers to PrEP uptake, yet the relative impacts of PrEP internalized stigma and logistical barriers (e.g., Cost; time) to PrEP use are understudied. It may be meaningful to investigate potential interactions between internalized stigma and logistical barriers to PrEP use. We utilized data from 827 Black and Hispanic/Latinx SMMTW ( = 25.09) in the US and found that greater PrEP-related internalized stigma and greater PrEP logistical barriers were independently significantly associated with lower likelihood of current PrEP use, but PrEP-related internalized stigma became a non-significant predictor when included in a multivariable model. We found a significant interaction between PrEP-related internalized stigma and logistical barriers to PrEP use, such that the association between internalized stigma and likelihood of current PrEP use was only significant at lower levels of logistical barriers to PrEP use. Findings highlight the need to reduce logistical barriers to PrEP use, and for clinicians to acknowledge the role of stigma for individuals who otherwise do not report logistical barriers.

摘要

尽管在艾滋病毒预防方面取得了进展,例如暴露前预防 (PrEP),但在获得 PrEP 方面,黑人和西班牙裔/拉丁裔顺性别性少数男性和跨性别女性 (SMMTW) 之间仍存在不平等现象。研究人员记录了阻碍 PrEP 接种的多种障碍,但 PrEP 内化污名和使用 PrEP 的后勤障碍(例如成本;时间)的相对影响仍研究不足。调查 PrEP 使用的内化污名和后勤障碍之间可能存在的相互作用可能具有重要意义。我们利用了来自美国 827 名黑人和西班牙裔/拉丁裔 SMMTW( = 25.09)的数据,发现与 PrEP 相关的内化污名和更多的 PrEP 后勤障碍与当前使用 PrEP 的可能性较低独立相关,但当纳入多变量模型时,与 PrEP 相关的内化污名不再是一个显著的预测因素。我们发现 PrEP 相关内化污名和 PrEP 使用后勤障碍之间存在显著的相互作用,即内化污名与当前 PrEP 使用可能性之间的关联仅在 PrEP 使用后勤障碍较低水平时才具有显著性。研究结果强调了减少 PrEP 使用后勤障碍的必要性,同时也需要临床医生承认污名对于那些没有报告后勤障碍的个人的作用。

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PLoS One. 2020 Nov 5;15(11):e0241340. doi: 10.1371/journal.pone.0241340. eCollection 2020.
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HIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States.美国全国性活跃跨性别者概率抽样人群中的 HIV 检测和 PrEP 使用情况。
J Acquir Immune Defic Syndr. 2020 Aug 15;84(5):437-442. doi: 10.1097/QAI.0000000000002403.
3
Sexuality Disclosure in U.S. Gay, Bisexual, and Other Men Who Have Sex With Men: Impact on Healthcare-Related Stigmas and HIV Pre-Exposure Prophylaxis Denial.美国男同性恋、双性恋和其他与男性发生性行为者的性行为披露:对与医疗保健相关的污名化和 HIV 暴露前预防拒绝的影响。
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Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review.美国广泛使用暴露前预防措施的障碍:叙事性综述。
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