College of Nursing, Florida State University, Tallahassee, FL; and.
Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL.
J Acquir Immune Defic Syndr. 2024 Oct 1;97(2):99-106. doi: 10.1097/QAI.0000000000003474.
Research has linked stigma surrounding preexposure prophylaxis (PrEP) to poor HIV prevention outcomes, including PrEP adherence. However, there remains a limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth. In this study, we aimed to investigate the indirect effect of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma.
Participants included 235 SGM youth, assigned male sex at birth, aged 16-24, and self-reported HIV-negative, with an active PrEP prescription from the Prepared, Protected, emPowered randomized controlled trial. Participants were recruited from 9 clinics in the United States between 2019 and 2021. Using baseline data, we tested cross-sectional indirect and conditional indirect effects using the Statistical Package for the Social Sciences Process with confidence intervals and 2000 resamples.
We found significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence, which in turn resulted in both monthly and weekly optimal PrEP adherence (Indirect effects: B = -0.11, Standard Error [SE] = 0.05, CI: [-0.244 to -0.032]; B = -0.09, SE = 0.04, CI: [-0.191 to -0.014], respectively). Anticipated HIV stigma moderated these indirect effects (B = -0.11, SE = 0.08, CI: [-0.315 to -0.001]; B = -0.09, SE = 0.06, CI: [-0.245 to -0.001], respectively), suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma.
Results suggest that SGM youth who are on PrEP anticipating HIV stigma experience a compounding effect of PrEP stigma on PrEP confidence, consequently leading to suboptimal adherence. Interventions addressing the intersectionality of PrEP and HIV stigmas and enhancing confidence could improve PrEP adherence, particularly among SGM youth.
研究表明，与暴露前预防 (PrEP) 相关的污名与包括 PrEP 坚持在内的不良 HIV 预防结果有关。然而，人们对 PrEP 污名影响 PrEP 坚持的机制仍知之甚少，特别是在性少数群体和性别多样化青年 (SGM) 中。在这项研究中，我们旨在通过 PrEP 信心来研究 PrEP 污名对 PrEP 坚持的间接影响，并探讨预期 HIV 污名的调节作用。
参与者包括 235 名出生时被指定为男性、年龄在 16-24 岁之间、自我报告 HIV 阴性且正在服用 PrEP 的 SGM 青年，他们均来自美国的 9 家诊所，参与了 Prepared、 Protected、 emPowered 随机对照试验。我们使用基线数据，通过社会科学统计软件包 Process 中的置信区间和 2000 个重采样进行横截面间接和条件间接效应检验。
我们发现了显著的间接效应，表明 PrEP 污名与 PrEP 信心呈负相关，进而导致每月和每周最佳 PrEP 坚持 (间接效应：B = -0.11，标准误差 [SE] = 0.05，CI：[-0.244 至 -0.032]；B = -0.09，SE = 0.04，CI：[-0.191 至 -0.014])。预期的 HIV 污名调节了这些间接效应 (B = -0.11，SE = 0.08，CI：[-0.315 至 -0.001]；B = -0.09，SE = 0.06，CI：[-0.245 至 -0.001])，这表明在高而非低水平的预期 HIV 污名下，条件间接效应是显著的。
结果表明，正在服用 PrEP 的 SGM 青年如果预期会遭受 HIV 污名，那么他们在 PrEP 污名对 PrEP 信心的影响方面会经历一种叠加效应，从而导致 PrEP 坚持度不理想。解决 PrEP 和 HIV 污名交叉问题并增强信心的干预措施可以提高 PrEP 坚持度，特别是在 SGM 青年中。
