是什么促使男性开始使用暴露前预防（PrEP）？南非布法罗市开始使用 PrEP 的男性的一个横断面。
What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo city municipality, South Africa.
机构信息
The Desmond Tutu HIV Centre, University of Cape Town, Observatory, Cape Town, South Africa.
Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
出版信息
BMC Public Health. 2023 Mar 2;23(1):418. doi: 10.1186/s12889-023-15306-6.
BACKGROUND
Compared to women, South African men are less likely to know their HIV status (78% vs. 89%), have suppressed viral loads (82% vs. 90%), or access HIV prevention services. To achieve epidemic control where heterosexual sexual behavior drives transmission, interventions to improve the uptake of HIV testing services (HTS) and prevention services must also target cis-gendered, heterosexual men. There is limited understanding of these men's needs and wants with regards to accessing pre-exposure prophylaxis (PrEP).
METHODS
Adult men (≥ 18 years) from a peri-urban community in Buffalo City Municipality were offered community-based HTS. Those who received a negative HIV test result were offered community-based, same-day oral PrEP initiation. Men initiating PrEP were invited to participate in a study exploring men's HIV prevention needs and reasons for initiating PrEP. An in-depth interview guide, developed using the Network-Individual-Resources model (NIRM), explored men's perceived HIV acquisition risk, prevention needs, and preferences for PrEP initiation. Interviews were conducted by a trained interviewer in isiXhosa or English, audio-recorded and transcribed. Thematic analysis was used, guided by the NIRM to generate findings.
RESULTS
Twenty-two men (age range 18-57 years) initiated PrEP and consented to study participation. Men reported elevated HIV acquisition risk associated with alcohol use and condom-less sex with multiple partners as facilitators driving PrEP initiation. They anticipated social support from family members, their main sexual partner and close friends for their PrEP use, and discussed other men as important sources of support for PrEP initiation. Nearly all men expressed positive views of people using PrEP. Participants believed HIV testing would be a barrier for men interested in accessing PrEP. Men recommended that access to PrEP be convenient, rapid, and community-based (i.e., not clinic-based).
DISCUSSION
Self-perceived risk for HIV acquisition was a major facilitator for men's PrEP initiation. Although men expressed positive perceptions of PrEP users, they noted that HIV testing may be a barrier to PrEP initiation. Finally, men recommended convenient access points to facilitate PrEP initiation and sustained use. Gender-responsive interventions tailored to men's needs, wants, and voices will facilitate their uptake of HIV prevention services, and help to end the HIV epidemic.
背景
与女性相比，南非男性了解自己 HIV 状况的可能性较低（78% 对 89%），病毒载量得到抑制的可能性较低（82% 对 90%），或获得 HIV 预防服务的可能性较低。为了在异性性行为驱动传播的情况下实现流行病控制，改善艾滋病毒检测服务（HTS）和预防服务的获取，也必须针对 cis 性别、异性恋男性。对于这些男性在获得暴露前预防（PrEP）方面的需求和诉求，了解有限。
方法
布法罗市都会区的一个城市社区，邀请成年男性（≥18 岁）参加社区为基础的 HTS。那些接受 HIV 阴性检测结果的人将获得社区提供的当日口服 PrEP 启动服务。邀请开始 PrEP 的男性参加一项研究，探索男性的 HIV 预防需求和启动 PrEP 的原因。一份使用网络-个体-资源模型（NIRM）开发的深入访谈指南，探讨了男性对 HIV 感染风险的感知、预防需求和对 PrEP 启动的偏好。访谈由一名受过培训的访谈员以 isiXhosa 或英语进行，录音并转录。使用主题分析，根据 NIRM 生成发现。
结果
22 名年龄在 18-57 岁之间的男性开始服用 PrEP 并同意参与研究。男性报告称，与酒精使用和与多个伴侣发生无保护性行为相关的 HIV 感染风险增加，这是推动 PrEP 启动的因素。他们预计会得到家庭成员、主要性伴侣和亲密朋友对他们 PrEP 使用的社会支持，并讨论了其他男性对 PrEP 启动的重要支持来源。几乎所有男性都对使用 PrEP 的人持积极看法。参与者认为 HIV 检测可能是对有兴趣接受 PrEP 的男性的一个障碍。男性建议方便、快速和基于社区的 PrEP 获得途径（即非诊所途径）。
讨论
自我感知的 HIV 感染风险是男性 PrEP 启动的主要促进因素。尽管男性对 PrEP 用户表示了积极的看法，但他们指出，HIV 检测可能是 PrEP 启动的一个障碍。最后，男性建议方便的切入点来促进 PrEP 的启动和持续使用。针对男性的需求、愿望和声音的性别响应干预措施将促进他们对 HIV 预防服务的获取，并有助于终结 HIV 疫情。
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