Turpin Rodman, Camp Aaron D, Mandell C J, Mandeville Julia, Davidson Mhonde Rochelle R, Smith Jamil, Liu Hongjie, Dyer Typhanye, Mayer Kenneth H, Boekeloo Bradley
Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA.
Heller School for Social Policy and Management, Brandeis University, Waltham, MA, 02453, USA.
AIDS Behav. 2025 Jan;29(1):187-197. doi: 10.1007/s10461-024-04481-1. Epub 2024 Sep 17.
Black sexual minority men (BSMM) remain disproportionately affected by HIV, yet Pre-exposure prophylaxis (PrEP) uptake in this population remains relatively low. Informed by minority stress theory, PrEP stigma may manifest in and exacerbate societal marginalization based on sexuality and race. We used an exploratory sequential mixed-methods approach to determine if PrEP-specific stigma was associated with reduced PrEP uptake among BSMM, and qualitatively explored how PrEP use is stigmatized among BSMM. We analyzed cross-sectional data from a pilot sample of BSMM (n = 151) collected in late 2020 in the United States, testing for associations between PrEP stigma and PrEP use using modified Poisson regression. Subsequently, we selected participants (n = 23) from this sample for qualitative interviews starting in 2022. Responses to questions related to PrEP stigma were analyzed using thematic analysis. PrEP stigma was associated less than half the PrEP use (aPR = 0.43, 95% CI = 0.24, 0.75) among BSMM after adjustment. Qualitatively, we identified three major themes in how PrEP use is stigmatized among BSMM: PrEP-specific sexual stigma, intersections between PrEP and HIV stigma, and PrEP misinformation and disinformation. Aligned with minority stress theory, each theme was based in part in stigma related to sexuality or race. We found strong relationships between PrEP stigma and PrEP use independent of several sociobehavioral factors. Each of our themes were based in part in minority stressors, and underscore the importance of culturally competent PrEP promotion efforts towards BSMM. Addressing stigma is a core component of health equity efforts towards ending the HIV epidemic.
黑人性少数群体男性（BSMM）受艾滋病毒影响的比例仍然过高，但该人群的暴露前预防（PrEP）使用率仍然相对较低。根据少数群体压力理论，PrEP污名可能表现为并加剧基于性取向和种族的社会边缘化。我们采用探索性序列混合方法来确定特定于PrEP的污名是否与BSMM中PrEP使用率降低相关，并定性探索在BSMM中PrEP的使用是如何被污名化的。我们分析了2020年末在美国收集的BSMM试点样本（n = 151）的横断面数据，使用修正泊松回归测试PrEP污名与PrEP使用之间的关联。随后，我们从该样本中选择了参与者（n = 23）进行从2022年开始的定性访谈。使用主题分析对与PrEP污名相关问题的回答进行了分析。调整后，PrEP污名与BSMM中不到一半的PrEP使用相关（aPR = 0.43，95%CI = 0.24，0.75）。在定性方面，我们确定了在BSMM中PrEP使用被污名化的三个主要主题：特定于PrEP的性污名、PrEP与艾滋病毒污名的交叉点以及PrEP错误信息和虚假信息。与少数群体压力理论一致，每个主题部分基于与性取向或种族相关的污名。我们发现PrEP污名与PrEP使用之间存在紧密关系，且不受几个社会行为因素的影响。我们的每个主题部分基于少数群体压力源，并强调了针对BSMM进行具有文化胜任力的PrEP推广工作的重要性。消除污名是结束艾滋病毒流行的健康公平努力的核心组成部分。
