Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA.
AIDS Behav. 2024 Sep;28(9):2926-2940. doi: 10.1007/s10461-024-04372-5. Epub 2024 May 23.
Latino sexual minority men (SMM) are a highly vulnerable population to HIV, and while pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical tool for HIV prevention among them, its utilization remains disproportionately low in this community despite its potential. Understanding the barriers along the PrEP continuum of care, known as the "PrEP cascade," is crucial for effectively implementing PrEP interventions. Therefore, the objective of our study was twofold: first, to explore the stage of Latino SMM in the PrEP cascade by examining disparities in demographics, social factors, and healthcare aspects; second, to gain insights from healthcare providers who have direct clinical experience with our population regarding the challenges faced by Latino SMM in accessing and adhering to PrEP. Based on the study findings, the majority of participants (n = 74; 49%) were in the contemplation stage, and only one in ten Latino SMM (10.6%) were currently adherent to PrEP. Compared to those who were at least second-generation, first-generation status had a positive association (B = 0.699, SE = 0.208, β = 0.351, p < .001) with engagement along the PrEP Contemplation Ladder. Conversely, having at least one parent who did not have legal residency, relative to those whose parents were both U.S. citizens or held legal residency documentation, was found to have a negative association (B = - 0.689, SE = 0.245, β = 0.245, p = .006) with engagement along the PrEP Contemplation Ladder. Additionally, discussing PrEP with a healthcare provider had a positive association (B = 0.374, SE = 0.179, β = 0.185, p = .038) with engagement along the PrEP Contemplation Ladder. Qualitative results from our study suggest that some Latinos who initially agreed to start using PrEP ended up getting lost in the care pipeline and failed to attend their scheduled appointments. Providers also noted that many patients lacked access to a pharmacy where they felt comfortable obtaining their PrEP prescription, leading them to discontinue use after only a few months. These findings emphasize the importance of considering the unique needs, culture, and background of Latinos, including care delivery and provider attitudes that can facilitate progress through the PrEP cascade.
拉丁裔性少数群体男性（SMM）是感染 HIV 的高危人群，尽管暴露前预防（PrEP）作为一种预防 HIV 的有前途的生物医学工具已经出现，但在该群体中，尽管其潜力巨大，但其利用率仍然低得不成比例。了解 PrEP 连续护理中的障碍，即“PrEP 级联”，对于有效实施 PrEP 干预措施至关重要。因此，我们的研究目的有两个：首先，通过检查人口统计学、社会因素和医疗保健方面的差异，探讨拉丁裔 SMM 在 PrEP 级联中的阶段；其次，从与我们的人群有直接临床经验的医疗保健提供者那里获得关于拉丁裔 SMM 在获得和坚持 PrEP 方面面临的挑战的见解。根据研究结果，大多数参与者（n=74；49%）处于考虑阶段，只有十分之一的拉丁裔 SMM（10.6%）目前坚持使用 PrEP。与那些至少是第二代的人相比，第一代的地位与参与 PrEP 考虑阶梯呈正相关（B=0.699，SE=0.208，β=0.351，p<.001）。相反，与父母双方都是美国公民或持有合法居住证件的人相比，至少有一位父母没有合法居住身份的人，与参与 PrEP 考虑阶梯呈负相关（B=-0.689，SE=0.245，β=0.245，p=0.006）。此外，与医疗保健提供者讨论 PrEP 与参与 PrEP 考虑阶梯呈正相关（B=0.374，SE=0.179，β=0.185，p=0.038）。我们的研究的定性结果表明，一些最初同意开始使用 PrEP 的拉丁裔人最终在护理管道中迷失，未能按时参加预约。提供者还指出，许多患者无法获得他们感到舒适获得 PrEP 处方的药房，导致他们在仅仅几个月后就停止使用。这些发现强调了考虑拉丁裔人的独特需求、文化和背景的重要性，包括可以促进 PrEP 级联进展的护理提供和提供者态度。
