Dillon Frank R, Ertl Melissa M, Eklund Austin C, Westbrook Jaelen, Balek Gabrielle, Algarin Angel, Martin Jessica, Sánchez Francisco J, Ebersole Ryan
School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA.
HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Arch Sex Behav. 2024 Mar;53(3):1197-1211. doi: 10.1007/s10508-023-02776-3. Epub 2024 Jan 11.
Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.
拉丁裔男同性恋者、双性恋者以及其他与男性发生性行为的男性（LMSM）报告称，他们的暴露前预防（PrEP）使用率低于白人、非拉丁裔的同类人群。我们推测，这种差异部分归因于社会生态因素，而这些因素可通过预防干预措施加以解决。在这项回顾性研究中，我们首先检查了253名LMSM的数据，以根据LMSM获取PrEP处方（接受情况）的概念框架，确定与若干社会生态因素之间是否存在理论上的关联。我们还在33名在评估前12个月开始使用PrEP的LMSM子样本中，探讨了PrEP使用频率（依从性）与社会生态因素之间的关系。在本研究中，该框架中的个体层面因素包括年龄和社会经济地位。对医疗保健的感知可及性代表了PrEP接受和依从的个体及社区层面决定因素。人际层面因素为社会支持和恋爱状况。结构/文化层面因素为性身份发展状况、异性恋自我呈现的男性气质规范、传统拉丁裔男性性别角色观念大男子主义和骑士精神、种族身份以及移民身份。结果表明，与同龄人相比，年龄较大的男性以及那些认可性身份发展综合/整合状态的人在其一生中更有可能获得PrEP处方。PrEP依从性与年龄较大、报告较高社会经济地位、报告更多评价性社会支持、自我认同为白拉丁裔、在美国出生以及认可较少的性身份不确定性和更多的异性恋自我呈现有关。研究结果明确了一些可改变的因素，这些因素可能为量身定制的、基于社区的预防工作提供参考，以增加PrEP的使用并减少LMSM中现有的艾滋病毒/艾滋病差异。
