在接受 PrEP 治疗的男同性恋、双性恋和其他男男性行为者中，对酒精消费、物质使用和心理健康对 PrEP 依从性和 condom 使用的感知影响：一项定性研究。
Perceived influence of alcohol consumption, substance use, and mental health on PrEP adherence and condom use among PrEP-prescribed gay, bisexual, and other men-who-have-sex-with-men: a qualitative investigation.
机构信息
Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, 33 Russell St., Toronto, ON, M5S 2S1, Canada.
Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
出版信息
BMC Public Health. 2022 Oct 7;22(1):1875. doi: 10.1186/s12889-022-14279-2.
BACKGROUND
Gay, bisexual, and other men-who-have-sex-with-men (GBMSM) continue to be disproportionately affected by Human Immunodeficiency Virus (HIV). Although HIV pre-exposure prophylaxis (PrEP) offers an effective means of reducing incident HIV among this population, the HIV-preventive success of oral-based PrEP is contingent upon regimen adherence. Elevated rates of alcohol-, substance use-, and mental health-related issues among GBMSM potentially hinder PrEP-taking efforts, however the evidence for this remains mixed. Accordingly, the present study entailed a comprehensive qualitative investigation to explore PrEP-prescribed GBMSM's perceptions surrounding the influence of alcohol, substance use, and mental health on PrEP adherence.
METHODS
PrEP-prescribed GBMSM (age ≥ 18 years; prescribed PrEP for ≥ 3 months) were recruited from two PrEP-delivery clinics in Toronto, Canada for focus groups as part of the formative phase of an alcohol-, substance use-, and mental health-focused randomized controlled intervention trial. Focus group discussions qualitatively explored perceived strengths and barriers associated with adherence to PrEP treatment; with an emphasis on alcohol, substance use, and mental health concerns. Condom use among PrEP-prescribed GBMSM within the context of these concerns was also discussed.
RESULTS
A total of five focus groups involving 35 GBMSM were conducted (4-10/group; mean age = 42.4; white = 71.4%). Although participants themselves generally reported successfully adhering to their PrEP regimens-resulting from a strong, underlying motivation for self-care-they recognized the detrimental impact that alcohol, substance use, and mental health had on adherence among their peers. In this regard, alcohol and substances were perceived as detracting from adherence only when consumption was excessive or temporally linked to PrEP dosing. Pronounced mental health issues (e.g., severe depression) were also seen as hindering adherence, although these effects were nuanced and perceived as person-dependent. Alcohol and substances were linked to condomless sex, regardless of PrEP use, and PrEP was therefore viewed as an HIV-protective 'safety net.'
CONCLUSIONS
Overall, findings suggest that PrEP adherence can often be successfully achieved in the presence of alcohol-, substance use-, and mental health-related issues. Augmenting self-care, and addressing pronounced addictions- and mental health-related concerns, may enhance PrEP treatment among GBMSM.
背景
男同性恋、双性恋和其他与男性发生性关系的男性（GBMSM）继续受到人类免疫缺陷病毒（HIV）的不成比例影响。尽管 HIV 暴露前预防（PrEP）为减少该人群中的 HIV 感染提供了有效手段，但口服 PrEP 的 HIV 预防效果取决于方案的遵守情况。GBMSM 中较高的酒精、物质使用和心理健康相关问题的发生率可能会阻碍 PrEP 的服用，但这方面的证据仍然存在分歧。因此，本研究进行了一项全面的定性调查，以探讨 PrEP 规定的 GBMSM 对酒精、物质使用和心理健康对 PrEP 遵守情况的影响的看法。
方法
从加拿大多伦多的两个 PrEP 提供诊所招募了 PrEP 规定的 GBMSM（年龄≥18 岁；规定 PrEP 治疗≥3 个月），参加焦点小组，作为酒精、物质使用和心理健康为重点的随机对照干预试验的形成阶段的一部分。焦点小组讨论从遵守 PrEP 治疗的角度定性探讨了与感知到的优势和障碍；重点关注酒精、物质使用和心理健康问题。还讨论了在这些问题的背景下，PrEP 规定的 GBMSM 中的避孕套使用情况。
结果
共进行了 5 次焦点小组，涉及 35 名 GBMSM（每组 4-10 人；平均年龄=42.4；白人=71.4%）。尽管参与者自己普遍报告成功遵守了他们的 PrEP 方案-这是自我保健的强烈、潜在动机的结果-但他们认识到酒精、物质使用和心理健康对他们的同龄人遵守情况的不利影响。在这方面，只有当饮酒过量或与 PrEP 剂量时间相关时，才会认为酒精和物质会削弱遵守情况。严重的心理健康问题（例如，严重抑郁）也被视为阻碍遵守的因素，尽管这些影响是微妙的，并且因人而异。无论是否使用 PrEP，酒精和物质都与无保护的性行为有关，因此 PrEP 被视为 HIV 保护的“安全网”。
结论
总体而言，研究结果表明，在存在酒精、物质使用和心理健康相关问题的情况下，PrEP 的遵守情况通常可以成功实现。增强自我保健，并解决明显的成瘾和心理健康相关问题，可能会增强 GBMSM 对 PrEP 的治疗效果。
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