Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Infect Dis. 2024 Sep 27;24(1):1035. doi: 10.1186/s12879-024-09801-3.
INTRODUCTION: Disparities in HIV and other sexually transmitted infections (STIs) persist among cisgender sexually minoritized men in the United States, driven in part by sexual behavior stigma, which is a barrier to clinic-based HIV/STI testing. HIV/STI biospecimen self-collection (HSBS) is a novel testing approach that mitigates stigma by allowing for some testing-related procedures to be conducted by oneself in one's home or any private location rather than a facility that requires interpersonal interactions and exposure to other members of the public. HSBS has demonstrated acceptability, feasibility, and effectiveness in testing uptake, but the extent to which stigma persists in HSBS and the quantification of stigma's role in HSBS is limited. METHODS: From 2019-2020, a nationwide sample of sexually minoritized men completed an online biobehavioral survey. Those who agreed to be recontacted (N = 4147) were invited to participate in HSBS; consented participants received self-collection kits that were laboratory-tested if completed. Sexual behavior stigma and HSBS associations were assessed with logistic regression. RESULTS: Mean age of participants was 35 years, 58% (2421/4147) were non-Hispanic white, 82% (3391/4147) were gay-identifying, 47% (1967/4147) had at least a college degree, and 56% (2342/4147) earned ≥ $40,000 annually; 27% (1112/4147) expressed HSBS interest, and 67% (689/1034) completed HSBS. HSBS interest and completion were less common among non-Hispanic Black sexually minoritized men and sexually minoritized men of lower socioeconomic status. Stigma from family and friends was significantly, negatively associated with HSBS interest (aOR = 0.72, 95% CI = 0.56, 0.93). Among those who had not tested for HIV/STIs in the past year, anticipated healthcare stigma was marginally, negatively associated with HSBS completion (aOR = 0.40, 95% CI = 0.15, 1.07). Among those who had never previously tested for HIV/STIs, anticipated healthcare stigma was significantly, negatively associated with HSBS interest (aOR = 0.32, 95% CI = 0.14, 0.72). CONCLUSIONS: Sexual behavior stigma persists as an HIV/STI testing barrier, even in the case of HSBS, limiting its utilization. Increasing HSBS among sexually minoritized men in the US necessitates stigma mitigation efforts that directly address equity in implementation.
简介：在美国，顺性别少数群体男性的 HIV 和其他性传播感染 (STI) 仍然存在差异，部分原因是性行为污名，这是阻碍诊所 HIV/STI 检测的一个障碍。HIV/STI 生物标本自我采集 (HSBS) 是一种新的检测方法，它通过允许一些与检测相关的程序在家中或任何私人场所由自己进行，而不是在需要人际互动和暴露于公众的其他成员的设施中进行，从而减轻了污名。HSBS 在检测参与度方面已被证明是可以接受的、可行的和有效的，但 HSBS 中污名持续存在的程度以及污名在 HSBS 中的作用量化程度有限。
方法：从 2019 年到 2020 年，一组全国性的少数群体男性完成了一项在线生物行为调查。那些同意被重新联系的人（N=4147）被邀请参加 HSBS；同意参与的参与者如果完成了自我采集套件，将接受实验室检测。使用逻辑回归评估性行为污名和 HSBS 之间的关联。
结果：参与者的平均年龄为 35 岁，58%（2421/4147）为非西班牙裔白人，82%（3391/4147）为同性恋，47%（1967/4147）至少拥有大学学历，56%（2342/4147）年收入≥$40,000；27%（1112/4147）表示有兴趣进行 HSBS，67%（689/1034）完成了 HSBS。非西班牙裔黑人少数群体男性和社会经济地位较低的少数群体男性进行 HSBS 的兴趣和完成率较低。来自家人和朋友的污名与 HSBS 兴趣显著负相关（aOR=0.72，95%CI=0.56，0.93）。在过去一年中未进行 HIV/STI 检测的人群中，预期的医疗保健污名与 HSBS 完成率呈边缘负相关（aOR=0.40，95%CI=0.15，1.07）。在从未接受过 HIV/STI 检测的人群中，预期的医疗保健污名与 HSBS 兴趣显著负相关（aOR=0.32，95%CI=0.14，0.72）。
结论：性行为污名仍然是 HIV/STI 检测的障碍，即使是在 HSBS 的情况下，也限制了其使用。在美国增加少数群体男性对 HSBS 的使用需要采取减轻污名的措施，直接解决实施过程中的公平问题。
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